General Permission Slip
Youth/child permission form for Cheyenne Berean Church activities.
Name of participant:
Participant's date of birth:
Does the participant have any of the following (check all that apply):
Special dietary needs
Physical conditions that limit activity
If yes, please explain below.
Participant's parent or guardian:
Participant's parent or guardian contact information:
I give permission for my child to participate in the activity listed above and authorize the adult leaders supervising this activity to administer emergency treatment to the above-named participant for any accident or illness and to act in my stead in approving necessary medical care. This authorization shall cover this activity and travel to and from this activity.
Yes (please type name below)
Digital signature of parent/guardian (type name below to give official permission):
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