Permission Slip

Just in case you join us for an outing that requires a permission slip,
Print and have this one signed and bring it along just in case…..

St. Mark's Presbyterian Church
310-326-4086

I hereby grant permission for my son/daughter,

____________________________ (birthdate ) _________

to attend _______________________________________.

In case of sickness or accident, the adult advisors have my authorization to secure any necesary medical attention if unable to contact me immediately:

Name: _______________________________________________

Address: _____________________________________________

City:____________________ Zip:___________

Emergency Contact Name and Phone:

___________________________________________________

Any Special Medical Concerns:

___________________________________________________

Health Insurance Information:

___________________________________________________

Signature of Parent/Guardian:

____________________________________ Date:___________

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