First Presbyterian Church Emergency Contact/ Permission Card for:  _______________

I give permission for my (child)ren: _________________________________________

to attend this event. Parent/Guardian who can be reached during the above event:

Name _________________________________________phone/cell_________________

**List any special medical or dietary information youth leaders should know on the back.

In the event of an emergency where medical treatment is required, I give permission for the youth leaders or church staff to obtain the services of a licensed physician.

Signed_____________________________________________Date__________________

I give permission for my child’s photograph to be taken at the youth even and used for church publicity

(newsletter, website) with the understanding that no personal information will be given.

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