General Permission Slip
Youth/child permission form for Cheyenne Berean Church activities.
Name of participant: *
Your answer
Activity: *
Your answer
Participant's date of birth: *
MM
/
DD
/
YYYY
Does the participant have any of the following (check all that apply): *
Required
If yes, please explain below.
Your answer
Participant's parent or guardian: *
Your answer
Participant's parent or guardian contact information: *
Your answer
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. *
Digital signature of parent/guardian (type name below to give official permission): *
Your answer
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