Permission Slip

The minor child listed below has my permission to participate in the trip to: KING & COUNTRY CONCERT | AUGUST 18TH 2022 with Vineyard Youth Group

By Signing this digial form I authorize Vineyard Christian Fellowship to consent to any treatment and/or hospital care deemed advisable by a physician for the above-named minor child, or myself, in the event a parent or guardian cannot be reached to authorize such treatment or care. I also give my permission for them to call an ambulance, or take the above-named child, or myself, to an available physician or medical treatment facility.

Any Known Allergies (for none put n/a)

Medications your child is taking (for none put n/a)

Medical Conditions:

Medical Insurance Carrier

Policy Number

Emergency Contact:

Relationship to Child:

Your Signature

Select a date

Relationship of Signer to Child: