MEMORIAL UNITED METHODIST CHURCH YOUTH GROUP
PERMISSION SLIP

I, as parent or guardian, give permission for my child, 

to attend the Memorial U.M.C. sponsored event,                                                       

on 
(Date)

__YES	IN CASE OF EMERGENCY, I AUTHORIZE ANY NECESSARY MEDICAL 
__NO	ATTENTION REQUIRED FOR THE HEALTH OF MY CHILD DURING THIS EVENT.

SIGNED	                                                                                                        PARENT OR GUARDIAN				DATE

TELEPHONE NUMBER

ADDITIONAL INFORMATION: