JOY CHURCH PERMISSION FORM 2023-2024
Activities Permission Slip For Joy Church 1435 Saint Croix Street, Prescott, WI 54021
Sign in to Google to save your progress. Learn more
Student Information
Student Name (First Last) *
Grade in School *
Birth Date (MM/DD/YY) *
Gender *
Address *
City
State
Zip Code
Student Cell #
Texting
Clear selection
Parent/Guardian Information
Parent/Guardian Name *
Address (if Different)
Cell # *
Texting
Clear selection
Email *
Additional Parent/Guardian Name
Cell #
Texting
Clear selection
Email
Emergency Contact Information
Name *
Cell # *
I give my permission for my child to participate in church activities with Joy Lutheran Church, Prescott, Wisconsin, and confirm my understanding of the following:
My son/daughter may be away from Joy Church Facilities. For different activities church groups may travel away from church property.

There is inherent risk of injury.  Joy Church offers a variety of activities, which present inherent risk of physical injury.  My child and I agree that they will follow directions of adult leaders and will act within the parameters of safe behavior whenever specific instruction are not given.

I authorize adult leaders to approve emergency medical treatment.  In case of emergency, I understand that every effort will be made to contact me.  If this is not possible, I give adult leaders my permission to act on my behalf in approving emergency medical treatment.  I understand that I am responsible for the cost of all medical or hospital care or treatment to be rendered to my child and I have included our insurance company and policy numbers should medical treatment be necessary.  
Parent/Guardian Electronic Signature *
Student Electronic Signature *
Electronic Date Stamp (MM/DD/YYYY) *
Insurance Information
Medical/Health Insurance Company
Policy Number
My Child's Health Concerns
Allergies/Allergic reactions
Medicine being taken by my child
Other information regarding my child's health that a doctor should know
Photographic Image Release
I hereby grant permission to use my child's likeness in photographs, video recordings, or electronic images in any and all of Joy's publications/communications, including website entries, without payment or any other consideration.  I understand and agree that these materials will become the property of Joy and will not be returned.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms