STUDENT NAME: _____________________________

PERMISSION SLIP FOR SH SNOW JAM 2012

Jan. 26-29, 2012
Grace Community Church 1234 Barger Place Ramona, CA 92065 (760) 789-0562 gccramona.com I am the legal parent/guardian of the student named above. I give my son/daughter/ward permission to attend the 2012 Sr. High Snow Jam on Jan. 26-29, 2011 I understand that skiing/snowboarding is a dangerous activity. In light of this I have signed the MEDICAL TREATMENT CONSENT & LIABILITY RELEASE FORM FOR MINORS. I authorize the adult leadership to approve medical treatment at their discretion as deemed necessary. In the event of injury or accident, the parents/guardians insurance carrier will be the primary carrier for the responsibility. I have read and understand the Tips and Guidelines. My son/daughter/ward has read and understands the Tips and Guidelines on the trip flyer. If my son/daughter is a discipline problem, I understand that I may be required to pick them up or arrange for immediate transportation home at my expense (as judged by the Youth Pastor & Leaders), and that money deposited for the trip is non-refundable. I understand that all deposits are NON-REFUNDABLE, and will not bug the Youth Pastor if my son/daughter/ward changes their mind, gets on restriction, their friend decides not to go, etc. Parent/Guardian information: Name: ___________________
____________________________________________ PARENT/GUARDIAN SIGNATURE

Phone:_________________ Phone: ________________

Name: ___________________

Other phone/mobile: __________________________ Other phone/mobile: __________________________ NOTES: Other emergency contacts: Name: ___________________ Name: ___________________ Phone:_________________ Phone:_________________

____________________________________________ PRINTED NAME

____________________________________________ STUDENT SIGNATURE

_____/_____/_______ DATE

Other phone/mobile: __________________________ * My child may be given ibuprofen for headaches/pain yes If yes, up to what dosage at a time __________mg. My child may bring a cell phone for emergencies only yes no no

IF YOU HAVE MORE THAN ONE STUDENT ATTENDING FROM THE SAME HOUSEHOLD, PLEASE FILL OUT A SEPARATE FORM FOR EACH STUDENT ATTENDING THE ACTIVITY.