Abundant Life Assembly of God                 (907) 262-7266  /  Fax (907) 260-4960

P.O. Box 781, Sterling Alaska  99672 ___________________   alag@acsalaska.net

PERMISSION SLIP

THE CHURCH HAS A NUMBER OF ACTIVITIES THAT MINORS PARTICIPATE IN.  WE ARE REQUESTING THAT THERE BE A CURRENT PERMISSION SLIP ON FILE.

I GIVE PERMISSION FOR_________________________________ TO PARTICIPATE IN THE FOLLOWING ACTIVITY_________________________________ ON ______________________ HELD AT __________________________________________.

HOME PHONE # _________________________  CELL PHONE # _________________________

PHYSICAL ADDRESS: _____________________________________________________________

EMERGENCY CONTACT: _______________________ EMERGENCY PHONE: ____________

I UNDERSTAND THAT ABUNDANT LIFE ASSEMBLY OF GOD DOES NOT CARRY SPORTS OR ACTIVITY INSURANCE AND WILL NOT ASSUME RESPONSIBILITY FOR INJURIES SUSTAINED IN CHURCH ACTIVITIES.  I ALSO UNDERSTAND THAT ACCIDENT INSURANCE COVERAGE IS MY RESPONSIBILITY.  I WILL ASSUME RESPONSIBILITY FOR INJURIES.

PARENT SIGNATURE ___________________________________________ DATE ____________

I GIVE PERMISSION FOR EMERGENCY TREATMENT TO BE ADMINISTERED TO MY CHILD/CHILDREN.

PARENT SIGNATURE____________________________________________ DATE ____________

I AUTHORIZE ABUNDANT LIFE ASSEMBLY OF GOD TO TRANSPORT MY CHILD/CHILDREN ON GROUP ACTIVITIES.

PARENT SIGNATURE __________________________________________ DATE _____________

I UNDERSTAND THAT THERE WILL BE A SIDE TRIP TO____________________________ DURING THIS GROUP ACTIVITY.  I AUTHORIZE MY CHILD/CHILDREN TO PARTICIPATE IN GROUPS OF 3+ BASED ON THE BUDDY SYSTEM OR IN PAIRS IF UPPER CLASSMEN.

                3+ BUDDY SYSTEM ________      OR       UPPER CLASSMEN PAIRS _______

PARENT SIGNATURE _________________________________________ DATE ______________