Off Campus Permission Slip

Lifeway Wesleyan Church Off-Campus Activity Permission Slip
I hereby give permission for
Name
to attend
Activity
at
Location
on
Date
I understand the departure time for this activity is
Time
and the group will return to the church at approximately
Return Time
I further understand the Lifeway Wesleyan Church assumes liability only as covered by the current medical and liability insurance effective on this date.
Please list any allergies
Please list any current medications your child is taking
THIS PERMISSION SLIP MUST BE SIGNED BY THE PARENT OR LEGAL GUARDIAN OF ANY PERSON UNDER AGE 18 AND RETURNED TO THE DIRECTOR OF ANY CHURCH ACITIVITY TAKING PLACE OFF THE CHURCH CAMPUS PRIOR TO DEPARTURE FOR THAT ACTIVITY.
Signed:
*By typing your name in the above box and placing a check mark in the box to the right, You agree that this is valid as your signature. If you ARE SIGNING THE FORM JUST print the COMPLETED form, sign and deliver to the church office.
Date signed:
Emergency phone numbers:
E-mail
Lifeway Wesleyan Activity Director’s Name and how to contact him/her during event in case of an emergency is:
Should be Empty: