New Goshenhoppen United Church of Christ Permission Form

My child,____________________________________ has my permission to attend
                                        (name)

the ______________________________which the church has planned on ___________________.

(activity)                                                        (date)

I have read, understood and abide by the release on the back of this form.

Signed, __________________________________     Date ________________________

In case of an emergency, please contact:

Name___________________________________   Phone________________________

Address________________________________________________________________


Medical Information: please list any pertinent health information pertaining to your child. (i.e. severe allergies, prescription medicines).

Release Form

This release is executed between the New Goshenhoppen United Church of Christ and the parent(s) of the youth whose name is listed below. Such release applies for any and all loss or damage, and any claim or damage resulting from any church sponsored activity in which your child is involved.

The parent(s) recognizes and affirms that youth group activities may be hazardous and include but are not limited to: hayrides, horseback riding, skiing, skating, tubing, amusement park rides and any other activity in which the church youth may engage. The parent(s) recognizes that their youth participate in such activities at their own risk, that they voluntarily assume those risks, and that they are fully familiar with all of the inherent dangers.

By signing this form, the parent(s) also releases all youth leaders and/or any member of New Goshenhoppen Church from any liability whatsoever on account of first aid treatment or service rendered to their child during participation in any church youth group activity. In case of an emergency, every effort wilI be made to contact parents. Signature on this release form hereby grants permission for my child to receive all necessary medical treatment. The parent(s) further states that he/she has carefully read this release and knows the contents thereof, and signed this release of their own free act.

Parent's Signature__________________________________  Date_________________________

Youth's Name_____________________________________