Youth Parental Permission Form - Mount Hermon Church

Child Information

Child's Name: *

Address *

Phone number *

Birthdate *

Grade *

School *

Emergency Information

Emergency Contact Name *

Permissions

Permission for Child to be Photographed *

I DO give permission for my child to be photographed for the use of church promotion vie pictures, directory, website and / or social media.

YES

NO

Signature & Release *

I do hereby give my permission for my child to attend any event with Mount Hermon Church of Jay Oklahoma. I release Mount Hermon Church and the sponsors from liability for any accident that may occur during the events, or while traveling to, from and during trip. I understand the event will be appropriately chaperoned.
Additionally, in the event this student becomes ill or sustains an injury, I give permission to those in charge to take necessary steps in administering proper medical treatment. In the event I cannot be reached by phone, I consent to the administration of treatment to be rendered to my child upon the advise of a duly-licensed physician and/or any incident occurring to my child resulting from reasonable activities during these events.