Parental Consent to Participate
at Farmtastic
Please return this completed form to your youth pastor or sponsor. Be sure it includes your parent’s signature, phone number, and date.
Name: ______
Age: ______Sex: M / F
Address: ______
City:______State: ______
Church Name: ______
Church City: ______State: ______
Youth Pastor: ______
Medical Release
I hereby give permission for my child to take part in all Farmtastic Youth Rally activities (unless otherwise indicated
on back of this sheet) and absolve Farmtastic Youth Rally from liability to me or my child because of any injury to my child while attending. In case of medical emergency, I understand every effort will be made to contact the parents. In the event I cannot be reached, I hereby give permission to the Farmtastic Youth Rally Nurse to secure proper treatment for my child.
______
Signature of Parent / Legal Guardian Date
□ Check here if restrictions are listed on the back
Please list a phone number a parent can be reached at on
the day of the event ______
Parental Consent to Participate
at Farmtastic
Please return this completed form to your youth pastor or sponsor. Be sure it includes your parent’s signature, phone number, and date.
Name: ______
Age: ______Sex: M / F
Address: ______
City:______State: ______
Church Name: ______
Church City: ______State: ______
Youth Pastor: ______
Medical Release
I hereby give permission for my child to take part in all Farmtastic Youth Rally activities (unless otherwise indicated
on back of this sheet) and absolve Farmtastic Youth Rally from liability to me or my child because of any injury to my child while attending. In case of medical emergency, I understand every effort will be made to contact the parents. In the event I cannot be reached, I hereby give permission to the Farmtastic Youth Rally Nurse to secure proper treatment for my child.
______
Signature of Parent / Legal Guardian Date
□ Check here if restrictions are listed on the back
Please list a phone number a parent can be reached at on
the day of the event ______