Parental Consent to Participate
at Farmtastic

  

Please return this completed form to your youth pastor or sponsor. Be sure it includes your parent's signature, phone number, and date.

Name: ______________________________________________

Age: ______________      Sex:   M /   F

Address: ____________________________________________

City:_____________________________ State: _____________

Church Name: _______________________________________

Church City: __________________________ State: _________

Youth Pastor: ________________________________________


Medical Release
I hereby give permission for my child to take part in all Farmtastic Youth Rally activities
(unless otherwise indicated on back of this sheet) and absolve Farmtastic Youth Rally from
liability to me or my child because of any injury to my child while attending. In case of
medical emergency, I understand every effort will be made to contact the parents.
In the event I cannot be reached, I hereby give permission to the Farmtastic Youth Rally Nurse
to secure proper treatment for my child.

____________________________________      ____________    ________________________________________________

Signature of Parent / Legal Guardian                     Date              Print Name of Parent

  __    Check here if restrictions are listed on the back

Please list a phone number where a parent can be reached on the date of the event: ____________________.