Permission Form

I hereby give permission to (first & last name)

To attend (name of event)

In case of emergency, please contact

Phone number

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 First United Methodist Church staff and members in attendance at the above stated event. Beyond that, the First United Methodist Church will assume NO responsibility. Does your youth have any known allergies? It is assumed that all due care and precaution will be taken by the First United Methodist Church staff and members in attendance at the above stated event. Beyond that, the First United Methodist Church will assume NO responsibility. Does your youth have any known allergies? Yes (please list below) No

Please list any known allergies

Will your youth be taking any medication during the event? Will your youth be taking any medication during the event? Yes (please list below) No

Please list medications

Ibuprofen or acetaminophen can be administered to my youth if requested for minor aches or pains. Ibuprofen or acetaminophen can be administered to my youth if requested for minor aches or pains. Yes No

An updated Registration Form for Children and Youth for my youth is on file in the church office. An updated Registration Form for Children and Youth for my youth is on file in the church office. Yes No (if no, a registration form can be found on the website)

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 CFUMC's Digital Policy no identifying information, including names, will be posted 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 CFUMC's Digital Policy no identifying information, including names, will be posted Yes No

Parent/Guardian Signature (typing name will indicate a signature)

I understand that my behavior is either a positive or negative reflection of Chelsea First United Methodist Church, agree to participate to the fullest of my ability, and to follow the rules of the event. Child or Youth Signature: * I understand that my behavior is either a positive or negative reflection of Chelsea First United Methodist Church, agree to participate to the fullest of my ability, and to follow the rules of the event. Child or Youth Signature: * Yes No

Child or Youth signature