I, _________________________________________[name of parent or guardian] give permission for my son/daughter______________________________________________ to participate in the _____________________________________________ [name of the event] sponsored by ____________________________________________of Central Presbyterian Church of Lafayette, Indiana.

It is my understanding that the event will be held on ______________from_______ to ____________ [time and dates]. The location of the event will be _________________________________________________, which will be reached by _________________ [mode of transportation].

I have completed all forms [health and medical releases] as required by the leaders of the event. I have also read all of the information with regard to itinerary, schedule and group rules.

Should emergency medical treatment be necessary I authorize_____________________________________________ [name of group leader and/or leaders] to act on my behalf and approve appropriate treatment.

Date:____________________

Signature: __________________________________ [parent or guardian]