Please complete and send to DRE Barb electronically PDQ!

1. TJ Sr. Youth Group Event Permission Slip
Youth Game Day, Sunday October 2nd
Permission Slip Due Date: Sunday, October 25th
Event Destination: TJUC
Starting Time and Place: 1:00 PM, YOUNG ROOM
Ending Time and Place: 6:30 PM, WESTON HALL
Adult Sponsors for this event:
Name: BARB FRIEDLAND Phone 425-6943 (CELL 548-5006)
Name: (2nd person pending) Phone: _____________________________
Additional Information: The event includes a challenge and leadership games
and activities led by Donald Taylor. We’ll wind up with a pizza dinner.
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(Please detach above for your records & turn in below portion on or before the due date)
Youth Game Day, Sunday October 2nd
I give my consent for my child, _______________________________, to participate
in the above mentioned event sponsored by _TJUC , I understand that the
church does not accept responsibility for any bodily injury incurred during this
event. I give permission for any emergency medical, surgical, diagnostic and
hospital care, treatment, and procedures to be performed by a licensed physician
or hospital when deemed immediately necessary or advisable by a physician to
safeguard my child’s health when I cannot be contacted. I agree to be responsible
for any expenses not covered by my insurance, which may be incurred as a result
of an accident or medical emergency involving my child.
Parent/Guardian Signature: ________________________________ Date: ________
PLEASE ATTACH COPY OF INSURANCE INFORMATION to this sheet.
My child has the following allergies, dietary restrictions, or medical conditions:
(please use back of sheet if need) _______________________________________________
________________________________________________________________________
Emergency contact information:
Primary - Name: __________________________ Phone: H: ____________________
Cell: _________________________
Secondary – Name: __________________________ Phone: _____________________