Road Trip/Event Permission For Friend/Guest

Please print and return to Pastor Wendy
Glenview United Methodist Youth Road Trip/Event Permission Form
For Friend/Guest of Glenview United Methodist Youth
Event Name___________________________Event Location____________________________Event Date_______________
Participant’s Name:__________________________________________Date of Birth:__________________________________
Parent/Guardian Name________________________________________Parent/Guardian Contact #_______________________
Allergies/Special Health Considerations/Medications/Dietary Needs:________________________________________________
_______________________________________________________________________________________________________
Physician’s Name____________________________________________Physician’s Phone #____________________________
Insurance Company___________________________________________Policy Holder’s Name___________________________
Policy Number_______________________________________________ID Number___________________________________
I give permission for my youth to attend the event named above, to travel to and from said event in vehicles driven by church-approved adult chaperones. I give the adult leaders of Glenview United Methodist Youth authority to act on my behalf with respect to my child’s health and safety while at the event, with the understanding that I will be contacted as soon as possible should the need arise. I release Glenview United Methodist Church and its representatives from liability in the event of accidental injury or illness. Parent/Guardian Signature:__________________________________Date____________________