Parent Permission Signature Card

Students Name

I hereby give permission for my child to attend the Merge

Summer Bash. I will arrange to have my child dropped off
and picked up at the designated time and location as
listed in the online registration form.

Should my child require immediate or emergency medical

care while engaged in the activity, in my absence, I
hereby grant the youth leaders authority to release my
child for medical treatment to such medical personnel as
appropriate under the circumstance.

In allowing my child to participate in the above-named

activity, I agree to release and hold harmless the Church
and its leaders, from any liability to or responsibility for
bodily injury, damage or illness to the above-identified
child.

During the feild games and BBQ my child understands

they must remain with the group. If my child is attending
the Tomlinson Aqua park they will bring the $3.50
entrance fee and will follow the pool guidelines.

Proper swimwear attire is required for the activities and

we ask that everyone chose swimwear that is modest and
appropriate.

Date:

Parent’s Name (Printed)

Parent’s Signature

Student Signature

Emergency Contact :

Phone #