Tehillah Church

Permission Slip

Tehillah Church Permission slip for minors under the age of 18

Person completing this form is stating that they are Parent and or legal guardian of minor and therefor give permission for their child to attend an event hosted by GenZ or Children's ministry
FRIDAY, JULY 26 AT 6:00PM - 8:30PM

Location & Event: Water Day | Yokuts Park 4200 Empire Dr. Bakersfield, CA

Parent / Guardian First Name

Last Name

Phone Number

Minors First Name

Last Name

Person Responsible to pick up minor:

I grant Tehillah Church Staff members permission to seek medical assistance for my child, in case of an accident that requires medical attention. If you agree please enter your full name below:

**In case of an emergency/accident I release Tehillah Church and its staff members from any liability that might occur to my child due to her own misconduct or decision. Furthermore, I take full responsibility for any accidents or liabilities caused to third parties by my child due to her actions or misconduct.

Emergency Contact First Name

Last Name

Emergency contact Phone Number

**Confidential Information concerning my child: Please write down any medical information that is necessary for the wellbeing of your child and personal issues we as a staff should be on watch for in order to care for them adequately.

Allergies to medications:

Other allergies:

Medical conditions:

Prescription Medications minor is currently taking:

In case of an emergency/accident I, Tehillah and its staff members from any liability that might occur to my child due to her own misconduct or decision. Furthermore, I take full responsibility for any accidents or liabilities caused to third parties by my child due to her actions or misconduct. If you agree please enter your full name below:

I have gone over these requirements and in my awareness of all that it encompasses. I, sign this permission form, willfully on this date (enter todays date):

Signature (type your full name):

Submit

Permission Slip

Tehillah Church Permission slip for minors under the age of 18

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