Permission Form

First Presbyterian Church of South Bend

Parent/Guardian Permission Form for Child/Youth Activities


This form is required for all children and youth in grades kindergarten through twelve participating in off-site activities, and must be on file in the Church Office for your child or youth to be included in any such events.

I, _________________________________________(name of parent or guardian) give permission for my son/daughter ______________________________ to participate in __________________________ _____________________________________________ (name of the event) sponsored by ___________

_____________________________________of First Presbyterian Church.


It is my understanding that the event will be held on _________________________ from____________ to ______________ (date and time).  The location of the event will be ___________________________

______________________________, which will be reached by ________________________ (mode of transportation).


I have completed all forms (including Child/Youth Information and Medical Information and Release) as required by the leaders of the event. I have also read all of the information with regard to itinerary, schedule and group rules.


Is there any other pertinent information that you would like us to have about your child? (e.g. custodial arrangements, medications/prescriptions, health/behavioral issues, persons to whom your child should not be released)?





Should emergency medical treatment be necessary I authorize _________________________________

_________________________________ (name of group leader and/or leaders) to act on my behalf and approve appropriate treatment.



Parent or Guardian Signature __________________________­­__________

Date _______________________




Leader in Charge Signature______________________________________

Date Received ______________________


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