Youth Permission Slip
I, the undersigned, request that my child, _______________________________________________, be permitted to participate in New Horizon Christian Fellowship’s Youth
Event:________________________________ on _______________________ at _______________. I hereby waive all claims which I might have against New Horizon Christian Fellowship, their agents and employees, of all liability during this event.
Emergency Contact: __________________________ Emergency Phone: ______________________
Home Phone: __________________________ _____________________________________________________
(Signature and Date)
Emergency Medical Treatment
Please list any information that may be helpful to the adult leaders or physician in case of an emergency. Please include: allergies, medications, medical history, etc: _______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
Insurance Company_____________________________ Policy/Group#_________________________
Doctor____________________________ Phone (___)_____________________________
Address_________________________________________________________________________________________________________________________________
In case of emergency, I understand that every effort will be made to contact me. In the event that I cannot be reached, I hereby give my permission to contact the physician on this form. I give my permission to the supervising New Horizon Christian Fellowship leader in charge, to secure proper emergency medical treatment. Including, but not limited to: hospitalization, anesthesia, surgery or injections of medication.
Signature of parent or guardian________________________________________________________