Tehillah Church

Permission Slip

Tehillah Christian Academy 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 therefore give permission for their child to attend an event hosted by Tehillah Christian Academy
Monday , February 10th- Thursday, February 13th

Location & Event: TCA Winter Camp | 57611 Eshom Valley Dr. Badger, CA 93603

Parent / Guardian First Name

Last Name

Phone Number

Minors First Name

Last Name

Person Responsible to pick up minor:

I grant Tehillah Christian Academy 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 Christian Academy and their staff members from any liability that might occur to my child due to his/her own misconduct or decision. Furthermore, I take full responsibility for any accidents or liabilities caused to third parties by my child due to his/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 his/her own misconduct or decision. Furthermore, I take full responsibility for any accidents or liabilities caused to third parties by my child due to his/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 Christian Academy Permission slip for minors under the age of 18

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