Church Event Parental Permission Form
Please complete this form to authorize your child’s participation in the church event. All information is required for the safety and supervision of minors.
Parent/Guardian Full Name
*
First Name
Last Name
Child’s Full Name
*
First Name
Last Name
Child’s Age or Grade
*
Please Select
Age 5
Age 6
Age 7
Age 8
Age 9
Age 10
Grade 1
Grade 2
Grade 3
Other (please specify below)
Event Name
*
Event Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Event Location
*
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Allergies or Medical Notes Relevant to Supervision
Who is authorized to pick up your child?
*
Parent/Guardian listed above
Other authorized adult (please specify below)
If 'Other authorized adult', please provide their full name
Permission and Authorization
*
I hereby give permission for my child to participate in the above church event. I authorize event leaders to seek emergency medical care if necessary and understand that I will be contacted as soon as possible in the event of an emergency. I confirm that all information provided is accurate.
Submit Permission
Should be Empty: