Permission Slip for First Presbyterian Church Special Event
Organizers: Youth Group Leaders
Parents Keep this Portion:
Event: Camp Canonicus Youth Retreat
Place: Camp Canonicus
Address: Rhode Island
Phone: (Bill Ferree Cell 401 924-2518)
Date/Time: Friday 28 August 2009 5 PM— Sunday 30 August 2009 2:00 PM
Transportation: Car pools
Cost: $50.00 per person. Need commitment and if possible a $20 deposit by 5 August 09.
Details: We will camp out at Cannonicus in Male or Female bunk houses. Food will be provided. We will plan this coming year’s Youth activities and hear teaching. A list of what to bring will be provided.
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Return this portion to the organizers
_____________________
has my permission to participate in the field trip to Camp
Canonicus to attend
(name)
the
Fall Youth Retreat at Camp Canonicus in Rhode Island from 5
PM Friday 28 August until 2 PM Sunday 30 Aug 2009. We will
leave from FPC at 5 PM and return youth to homes around
2:00 PM Sunday afternoon. I understand that the group will
travel together in the youth leaders’ cars. (Parents may
make arrangements to drop a participant off late or pick
them up early if necessary.)
I
release First Presbyterian Church, its employees and
volunteers from any liability arising out of any accident,
injury or sickness that may happen to my son or daughter.
I also
give permission for the provision of emergency medical
treatment to my son or daughter, that, in the sole judgment
of those administering such care, be necessary; and I
release those persons administering such care from any
liability arriving from providing
assistance.
During
the trip I/we can be reached at this phone number
__________________________________
(relation to
child)________________________(phone)___________________________________
Name (print)____________________________
Signature_____________________________________
Date_________________________________________
Please
list any allergies, handicaps, restrictions, medications or
other concerns on the back of this
sheet.
If
unreachable - our
back-up contact
is___________________________________________.
(name and phone number)