Permission Slip for Children's Choirs and Missions Trip
Wednesday, March 7, 2007
(2nd - 5th grades)
(Print this form, fill it out, and return to church)
I give ____________________________ my permission to go with the Second Baptist Church Children's
Choir and Missions organizations, to Lakewood Manor Retirement Home, 1900 Lauderdale Drive, Richmond, Virginia.
Parent/Guardian Name________________________________________ Phone______________________
Emergency Contact__________________________________________ Phone______________________
If a medical emergency should arise while at this event and I cannot be contacted, I hereby give permission to the chaperone to seek medical treatment for my child.
Insurance Company_________________________________________________________________
Policy No.________________________________ Group No.________________________________
Signature______________________________________ Relationship to child________________________