Single Event Permission Form

Single Event Permission, Authorization, and Release


I, 1.)                                              (“Parent”), am the parent and/or lawful guardian                                                                                                       (Type name of parent)

of 2.)                                                  (“Child”), a minor.  I understand                                                                          (Type name of child)

that the 3.)    _____________       of Sunnyside Christian Reformed Church                                                                   (Type name of organization)

is sponsoring the following event (“Event”): 4.)________________________                                                                                                              (Type name of event outing)

As Parent, I hereby give my Permission for Child to participate in the Event and all related activities. I also, hereby give Authority to the adult leaders of the Organization and any other employees, servants and agents of Sunnyside Christian Reformed Church (“SCRC Agents”) to consent, in my place and with the same authority as I have, to any medical treatment that may be required by Child in connection with the event.                   

Parental Consent  5.)___________________________(Type full name)

In consideration of the services performed by SCRC Agents, I hereby Release Sunnyside Christian Reformed Church and all SCRC Agents from any and all liability for any damage, injury or loss arising out of actions taken in good faith in connection with the Event, regardless of whether caused by the negligence of any party hereby released.

Liability Release 6.)__________________________(Type full name)

On Medication? 7.) o No          o Yes    8.) (If yes, please indicate in medication field)

Dated: 9.) ________________________________

Emergency Contact Number 10.) ______________________________________________             

Sunnyside CRC Youth Group Event Permission Form  


Please fill out all blanks below to the corresponding numbered questions

Single Event Slip:

* Parents Name
* Childs Name
* Name of organization (example GEMS, Salt-Teens, ect.)
* Event Name
* Parental Consent (1 required)
Yes   No
* Liability Release (1 required)
Yes   No
* Medication(s) (1 required)
Yes   No
* Medical Concerns/Medications
* Date of Consent
* Emergency Contact Number

* Email Address: