Permission/Consent

First Presbyterian Church

224 Barnwell Avenue NW

Aiken, SC 29801

803.648.2662

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First Presbyterian Church of Aiken, S. C.

Presbyterian Children’s Fellowship Event

224 Barnwell Ave. NW

Aiken, S. C. 29801

803-648-2662

Permission slip and Medical Consent Form

____________________________________ (Child’s name) has my permission to participate with FPCA Presbyterian Children’s Fellowship in the following

Activity: _______________________________________________

Date/time: ____________________________________________ Cost: _______________

We will be using a rental van for transportation. I understand that every precaution will be taken to assure the health and safety of my child. However, I give my permission to the leaders to obtain emergency medical treatment for my child. In the event of any accident, I am to be contacted immediately and I release the leaders and helpers from all liability resulting from any injury or accident during this time.

Special notes and needs for this event:

______________________________________________________

Parent Signature: ________________________________________________________

Date: _________________________ Emergency Number(s): ________________________________________________________

Please list any additional information that may be needed. (Ex. allergies, medications, etc.)

______________________________________________________________________________________________