I, _________________________________, give  permission for my child/children
               Parent or Guardian

__________________________________________ to attend the following Youth Group event:
            Child's Name

 _______________________________________on ___/___/___.
             Event Name                                                          Date

I understand that there will be adequate adult supervision, and all safety precautions will be taken.

X________________________________________________________ 
              Signature

Printed Name _______________________________________________Date ___/___/___

Home Phone __________________________  Work Phone__________________________