Parent Permission Form
Activity Information
To be completed by the activity sponsor
Name of Ministry
Your answer
Name of Ministry Coordinator
Your answer
Coordinator Telephone
Your answer
Description of Activity
Your answer
Date(s) of Activity
Your answer
Church Address
Your answer
Church Telephone
Your answer
Participant Information
To be completed by authorized guardian
Name of Participant
Your answer
Name of Parent/Guardian
Your answer
Participant Address
Your answer
Participant Telephone
Your answer
Name of Emergency Contact
Your answer
Emergency Contact (DAY) Telephone
Your answer
Emergency Contact (EVENING) Telephone
Your answer
List Allergies or Medical Conditions
Your answer
Is Sponsor Authorized to Approve Medical Treatment?
Is Participant Covered by Personal/Family Medical Insurance?
If Yes, Name of Insurer
Your answer
Policy or Group Number
Your answer
Parent Permission Form
I understand that Painesville Assembly of God has children and youth ministry programs which include Bible teaching, recreation, and direction on how to live a positive Christian life. By signing this form below, I give permission for my child, as named above, to attend the Painesville Assembly of God church and church sponsored events. I release the church and its representatives from any liability in the event of an accident en-route, during, or returning from an activity.
Emergency Medical Care Release
I do hereby state that I have legal custody of named child, a minor, who resides with me. While this minor is in the care of Painesville Assembly of God, I hereby authorize any Pastor, Teacher, Leader, or other responsible person of said church to consent to any X-ray, examination, anesthetic, medical or surgical treatment, and hospital care, to be rendered to this minor under the general or special supervision and on the advice of any physician or surgeon licensed to practice when such medical or surgical treatment is necessary. I am also aware that the administration of non-prescription medicines (band aides, ice packs, Tylenol, etc.) may be necessary. I willfully consent for my child to receive these from adult leaders if deemed necessary.
Transportation Release
I hereby authorize my child to travel with church groups to events located on/off church grounds at any time as authorized by the church’s leaders and/or teachers. I understand that my child may ride a bus, van or car to/from the Painesville Assembly of God church. I agree for my child to be transported in church-owned vehicles as well as parishioners’ personal vehicles when necessary. In the event of an accident, I will not hold the church, staff or child’s driver liable.
Does Participant Utilize Van Ministry for Transportation?
Disciplinary Clause
We are not responsible for student’s lost or stolen items while attending church events. We also reserve the right to inspect the contents of all personal belongings at any time. The confiscation and/or disposal of improper contents is up to the discretion of the Painesville Assembly of God Staff. In case of dismissal due to voluntary withdrawal or disciplinary actions, there will be no refund of event fees. Parents are also financially responsible to repair/replace any property, vehicle or equipment their child damages while behaving inappropriately.
Picture & Video Release
I understand that any pictures or video taken of children while attending church events will become the property of Painesville Assembly of God and may be used for the purpose of promoting church ministries.
Parent/Guardian Name
Your answer
Today's Date
MM
/
DD
/
YYYY
Parent/Guardian Signature
By selecting the "I Accept" button, you are signing this Parent Permission Form electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Permission Form. By selecting "I Accept" you consent to be legally bound by this Parent Permission Form's terms and conditions.
Parent/Guardian Signature
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