I hereby authorize my son/daughter, ____________________________________,

to attend the _______________________ on ___________________________ sponsored

by St. Lorenz Youth Ministry. This authorization extends permission to those adults in charge of this activity to authorize any needed medical attention on behalf of my child. In the event such medical services are required, I request that I be notified accordingly as soon as possible.

            In the event that rules/guidelines for the above listed activity are not followed, I understand that it may be necessary to contact me immediately.

 

___________________________________ Parent Signature

 

________________________ Telephone Number

 

Medic alert information

________________________________________________________________________