Children/Youth Permission Slip

I give permission for my child ____________________________________ to participate in _____________________________________________ on _________________________.

I understand that they will be in vehicles driven by members of Gateway Community Church. I will not hold Gateway Community Church or its members liable in any way for any injury sustained. I also give my permission for those adults in charge to obtain any medical care they feel is necessary for my child.

Insurance Co. _____________________________

Policy # _________________________________

Please include any pertinent allergy or medical information that relates to your child’s health.

Parent/Guardian Signature: _______________________________________

Phone: _______________________________________

Date: _______________________________________