Sandy Hook Youth Group Permission Slip 2026

Sandy Hook Youth Group Permission Slip 2026

This permission slip applies for all Sandy Hook UMC youth group activities in 2026.
Youth's Name

First NameLast Name
Youth's Date of Birth

MonthDayYear
Youth's E-mail
Use parent email address if youth has no email address.
Youth's Cell Phone Number

Area CodePhone Number
School
Grade
Allergies/Medical Conditions
Parent/Guardian Contact Information
Parent/Guardian's Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Cell Phone Number

Area CodePhone Number
Parent/Guardian Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Cell Phone Number

Area CodePhone Number
Emergency Contact Information

Please provide an emergency contact in case we are unable to reach a parent/guardian.
Emergency Contact Name

First NameLast Name
Relationship to Youth
Cell Phone Number

Area CodePhone Number
Medical Information
Medical Insurance Company, Address, Phone #, ID #
Prescription medication: (Name, Frequency, Amount, etc.)
Youth's Primary Care Physician
Youth's Primary Care Physician's Phone Number

Area CodePhone Number
Youth's Dentist
Youth's Dentist's Phone Number

Area CodePhone Number
I give permission for my youth (named above) to attend activities (social events, trips, service projects, etc.) associated with the Youth Group of Sandy Hook United Methodist Church of Columbus, IN.
I give permission for my youth to be transported to and from activities by hired, staff and volunteer drivers authorized by Sandy Hook United Methodist Church.
I give permission for my youth to be transported by other youth (who are licensed drivers) to and from activities.
I understand that I will be notified in the case of a medical emergency involving my youth. However, in the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event my youth is injured or becomes ill. I understand that the Church will not be responsible for medical expenses incurred but that it will be my responsibility as parent/guardian.
I give permission for Sandy Hook United Methodist Church staff or adult volunteers to administer prescription medication and common OTC medication (Tylenol, Ibuprofen, etc.) as needed.
I assume the responsibility for my youth's participation in all activities and will not hold Sandy Hook United Methodist Church, nor its Staff or Volunteers, liable for any illness or injury incurred at youth group activities at which every reasonable precaution has been taken.
I give permission for my youth’s photo/image and all other personal identifiers listed above to be published on the Sandy Hook United Methodist Church public website and/or social media.
Parent/Guardian Signature
Date

MonthDayYear
Should be Empty:

Sandy Hook Youth Group Permission Slip 2026

Parent/Guardian Contact Information

Emergency Contact Information

Medical Information