Permission Form

Youth & Child

Step 1 of 2

Required in order to attend any activities described as a Permission Slip Activity under the Safe Sanctuary Policy.

I hereby give permission for (child/youth name) *

to attend the following event *

on the following date *

at the following location *

In case of emergency, please contact *

Phone *

The following person(s) have permission to pick up my child(ren) *

It is assumed that all due care and precaution will be taken by the Chelsea First United Methodist Church staff and members in attendance at the above stated event. Beyond that, the Chelsea First United Methodist Church will assume NO responsibility.

Does your youth have any known allergies? *

Yes
No

If yes, please list

Will your youth be taking any medication during the event? *

Yes
No

If yes, please list

Consent

Yes, Ibuprofen or acetaminiphen can be administered to my youth if requested for minor aches or pains.
Yes, I give my consent for any pictures taken of my youth at the above stated event to be shared in any future youth publications and/or on the church's website. (According to Chelsea First United Methodist Church Digital Communication Policy, no identifying information, including names, will be posted alongside a child's image.)

Parent/Guardian Signature *

Date *

Our church culture

Chelsea First United Methodist Church (Chelsea First) is a Christ-centered congregation with a positive, open, and engaging spirit. We are the church for everyone, at all seasons of life, and bring a grounded, engaged, and supportive approach to religious worship while working passionately toward making a positive impact in our community.

CONTACT US
Chelsea First UMC
128 Park St., Chelsea, MI 48118
📞 (734) 475-8119
✉️ info@chelseaumc.org
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Permission Form

Required in order to attend any activities described as a Permission Slip Activity under the Safe Sanctuary Policy.

Medical Release Waiver

I agree to the following:

Our church culture

Subscribe to our church wide newsletter.