HSM Permission Slip
Permission Slip for Events
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Student's Name *
Event *
Date of Event *
MM
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DD
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YYYY
Insurance Company *
Insurance Policy Number *
Parent/Guardian Cell Phone *
Parent/Guardian Email *
Please include any pertinent allergy or medical information that relates to your child’s health:
By electronically signing my name below, I agree that I understand that my child will be driven in the church bus or vehicles driven by members of the The Haven Church of God.  I will not hold The Haven Church of God 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.   *
Date *
MM
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DD
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YYYY
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