Release Authorization Form & Parent Permission
St. John's Lutheran Church
1403 Newman St., Bloomer, WI 54724

This form must be electronically signed by a parent or legal guardian
Name of Child(ren)/Youth *
Name of Parent or Legal Guardian (first & last) *
Address (including city, state, and zip) *
Phone (Primary) *
Phone (Secondary)
My child has permission to sign out of Sunday/Wednesday Faith Formation Small Group and/or activities at St. John's Lutheran Church, 1403 Newman St., Bloomer, WI. Without adult supervision, they will be walking to... *
By signing and dating this form, I release St. John's Lutheran Church (address listed above) from all liability and/or responsibility when my child(ren)/youth leaved the building. *
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