Permission slip
 

PDY is the student ministry of Pleasant Dale Church
4505 W 300 N    Decatur, IN  46733  (260) 565-3797

 

 

As a parent/legal guardian of ______________________________, I have reviewed the information about the _____________________________ event on ___________, 2009, and give permission for the subject of this release to be involved in the overall activities.  I have reviewed the rules of the activities and agree that the subject of this release will abide by them.  I also acknowledge that if the subject of this release has to return home early for discipline violations, it will be at my expense.  I understand all reasonable safety precautions will be taken at all times by Pleasant Dale Church of the Brethren and its agents during the events and activities.  I authorize any treatment by an accredited hospital and/or physician deemed necessary for the subject of this release in case of an emergency.  I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold Pleasant Dale Church of the Brethren, its employees, and volunteer staff liable for damages, losses, illnesses, or injuries incurred by the subject of this form.

Parent/Legal Guardian Signature:______________________________________ Date:_____________

Print Signer's Name: _________________________________________________