St. Peter's Student Permission Slip
Please fill out the form below to give your student permission to attend an off-campus or special ministry event with St. Peter's Youth (SPY) ministries. 

**Please note: depending on the event, a second permission slip may be required from the secondary location or organization.
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What is the event that your student has permission to attend (please include the date(s) of the event/activity).
Student #1 Name
Student #1 Date of Birth
MM
/
DD
/
YYYY
Student #1 Cell Phone #
Student #2 Name
Student #2 Date of Birth
MM
/
DD
/
YYYY
Student #2 Cell Number
Address
Parent Email
Parent/Guardian Name(s)
Parent Cell #
Parent Cell #
Emergency Contact Person Name
Emergency Contact #
PERMISSION

I/We the undersigned have legal custody of the student named above, a minor, and have given our consent for him/her to attend events being organized by St. Peter’s United Methodist Church. 

I/We understand that there are inherent risks involved in any ministry or athletic event, and I/we hereby release the Church, its pastors, employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my/our child’s involvement. 

In the event that he/she is injured and requires the attention of a doctor, I/we consent to any reasonable medical treatment as deemed necessary by a licensed physician. 

In the event treatment is required from a physician and/or hospital personnel designated by St. Peter’s UMC, I/we agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. 

I/We also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. 

Further, I/we affirm that the health insurance information provided above is accurate at this date and will, to the best of my/our knowledge, still be in force for the student named above. 

I/we also agree to bring my/our child home at my/our own expense should they become ill or if deemed necessary by the student ministries staff member.
Parent/Guardian Electronic Signature
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