Generic Permission Slip

I HEREBY GIVE MY PERMISSION for my son/daughter,___________________________, participate/attend:
Activity: ___________________________________________________________
Date(s):______________________________________________________________
I realize that every precaution will be taken for the safety of my child. I agree not to hold St. Paul's United Methodist Church or its adult chaperones, paid or voluntary, responsible in any way for any accident which might occur. I further give my permission to the chaperones to obtain MEDICAL TREATMENT for my child should that be seen as necessary by them, medical personnel or other competent authority. My child's insurance information is given below.

INSURANCE CO.:_________________________ NO.:____________________

(Signed,) ____________________________________________________________

Date: ____________________
Telephone number(s) where you can be reached during the above times indicated:
(_____)-______-___________
(_____)-______-___________

This is a generic permission slip, please determine if there are any costs to this particular activity and when and where you need to pick your child up from this activity before leaving your child with St. Paul's.