AWANA Permission Slip

                                                                                               Permission Slip 

Medical Release Form

___________________________________ has my permission to ride the church van

(Child's Name)

and attend the AWANA program of the First Baptist Church of Lagrange, Ohio for the 2017-2018 year.

I understand that First Baptist Church of Lagrange and their sanctioned members are not liable in case of an accident. I understand that all precautions will be taken in order to provide safety on the van and at the AWANA program.

In the event I cannot be reached to make arrangements for emergency medical care at the time of illness or accident, I hereby authorize First Baptist Church to contact emergency medical personnel to care for my child.

*Please list any pertinent medical information that is vital in case of an emergency:

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_______________________________

Print name of parents/guardian

_______________________________

Signature of parents/guardian

_______________________________

Telephone number

First Baptist Church

200 Church Street

PO Box 136

Lagrange, Ohio 44050

(440) 355-4015

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