EMMANUEL BAPTIST CHURCH

YOUTH REVIVAL
Dear Parents,
Pastor Brian will be ministering at a youth revival at Emmanuel Baptist
Church on July 27, 2012 and is inviting your student to attend. Please
complete and return the attached permission slip and emergency form
as consent to your youths attendance on or before July 25, 2012.
Please feel free to contact our office at 919-402-9622 Ext. 4017 should
you have questions, concerns or desire additional information. We
thank you for your continued support and look forward to having your
youth on board!

Sincerely,
ONEL1FE Staff

Permission Slip
I, __________________________________________, am the parent and/or legal guardian of
_______________________________________, and agree that ONEL1FE Youth Ministry of World
Overcomers Christian Church is organizing the following outing:
Emmanuel Baptist Church
204 Turner Street
Thomasville, NC 27360
Date: July 27, 2012
Departure: ONEL1FE Facility 4:45pm
Return/Pick-Up: ONEL1FE Facility 12am
Attire: Casual Dress
Cost: $5

_______________________________________ has my permission to attend the trip listed above

and participate in all the related activities. I hereby accept any and all risk of injury
to my child and verify this statement with my signature below. I authorize the
World Overcomers Staff Members and Youth Leaders to obtain and consent to any
medical treatment in the event of injury or illness and agree to pay any expenses
incurred for treatment. World Overvcomers Christian Church and the employees,
servants and agents are hereby released from liability for all actions taken in good
faith during the trip.
Parent/Legal Guardian Name
______________________________________
Signature

______________________________________
Date

Emergency Contact Information

Please provide the following information
Parent Name(s)
________________________________________________________________________________________
Phone #: Home: ________________________ Cell: ____________________________________
E-mail: _______________________________________________________________________________
Students Insurance Carrier: ________________________________________________________
Insurance Number: __________________________________________________________________
Current Physician: ___________________________________________________________________
Current Physician Phone #: _________________________________________________________
Do you have an existing medical condition? Yes
No
If yes, please list:
_________________________________________________________________________________________
Do you have any food allergies? Yes No
If yes, please list:
_________________________________________________________________________________________
Are you currently taking any prescribed medications? Yes No
If yes, please list:
_________________________________________________________________________________________