LUMC Children and Youth Permission Slip and Medical Release 2023
By completing and submitting this form, I hereby give permission for my child to participate in all activities on site and off site (field trips) with Lawrence United Methodist Church Children and Youth Ministry from January 1 - December 31st of 2023.  I give permission for my child to ride in any vehicle designated by the adult in charge. I give permission for the person in charge to seek medical services if needed. I release Lawrence United Methodist Church and the sponsors of these activities and events from liability for any accident that may occur while participating in activities or traveling to and from events. It is my understanding that all activities and events are approved by the church and will be appropriately chaperoned by adult leaders and parents. 

In the event that my child becomes ill or sustains an injury during one of these activities or events, I give my permission to those in charge to take the necessary steps in administering proper medical treatment. In the event that I can not be reached by phone, I consent to the administration of treatment to my child upon the advice of a licensed medical professional. 
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Email *
Parent/Guardian(s) First and Last Name / Relationship *
Emergency Contact Info | Phone *
Child/Youth FIRST Name *
Child/Youth LAST Name *
Child/Youth Date of Birth *
MM
/
DD
/
YYYY
Child/Youth Grade (current) *
Known allergies? Please list and explain. Enter "None" if applicable.  *
Required medications or medical treatments? Please list and explan.  Enter "None" if applicable. *
Other information that you'd like us to know about your child/youth. Enter "None" if applicable. *
People Authorized to Pickup and Dropoff *
Home /Mailing Address *
By completing and submitting this form, I hereby give permission for my child to participate in all activities on site and off site (field trips) with Lawrence United Methodist Church Children and Youth Ministry from January 1 - December 31st of 2023.  I give permission for my child to ride in any vehicle designated by the adult in charge. I give permission for the person in charge to seek medical services if needed. I release Lawrence United Methodist Church and the sponsors of these activities and events from liability for any accident that may occur while participating in activities or traveling to and from events. It is my understanding that all activities and events are approved by the church and will be appropriately chaperoned by adult leaders and parents. 

In the event that my child becomes ill or sustains an injury during one of these activities or events, I give my permission to those in charge to take the necessary steps in administering proper medical treatment. In the event that I can not be reached by phone, I consent to the administration of treatment to my child upon the advice of a licensed medical professional. 
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