Rampage Youth Permission Slip
Permission form for events in which youth will participate
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date
*
/
Month
/
Day
Year
Date
Event?
*
Mentor Program
Other
Child(ren's) Name(s) & Birthday
*
Please list each child who has permission to attend this event & each child's birthday.
Medical note
*
Are there any medical conditions (i.e. allergies, epilepsy, asthma, diabetes, travel sickness, dietary restrictions, etc.) of which we should be aware? If not, please type N/A
Over-the-Counter Medications Do you give permission for your child/youth to be given over-the-counter medication as needed and as directed on the label to treat non- emergency medical conditions that do not require a doctor or hospital visit, such as a minor headache, stomachache, or allergic reaction (i.e. Tylenol, Advil, antacids, Benadryl, etc.) while at a youth ministry event?
*
Yes. I give permission for an adult youth leader to give my child over-the-counter medications as directed on an as needed basis to treat non-emergency medical conditions.
No. Contact me or get medical help if my child has any minor medical concerns.
Acknowledgement * I, the parent or guardian, give my child permission to attend and participate in this activity. I understand that care will be taken to ensure the health, safety, and welfare of my child. I realize and accept that in the event of my child’s behavior adversely affecting the safety of the activity, the organizers reserve the right to return my child home.
Submit
Should be Empty: