West Rockport Baptist Church Youth Group
Permission slip
My
Teen,____________________________, Has my Permission
to go on
The
Youth Group event.______________________________, on
___________________________,
from __________ to __________.
In
Case of an emergency you have my permission to seek medical attention.
Medical
insurance Company:______________________________________
Insured’s
name:_________________________________________________
Policy
#:___________________________
Parent
or guardian Signature:_______________________________________
Home
#______________ Cell#_______________
Work #_______________
For
your info, Youth leaders
Jay
Stein-# 596-6501 Home
Keith
& Dawn Daggett- Cell # 691-3575 Or 542-0337 Home # 594-7802
Bill
& Diane Patten Cell # Bill 975-3522, Diane 975-3523 Home# 785-3292
Greg
&