Dayton, Tennessee

Permission Slip for Outings

Clear Creek Baptist Church

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Permission Slip For Student Activities away from church

Y-WAM (grades 6-12)

TeamKID (grades K-5)

My student has permission to participate in Y-WAM and/or TeamKID activities away from Clear Creek Baptist Church.  These activities will always be supervised by responsible adult members of Clear Creek Baptist Church.  The adult responsible for my student has my permission to authorize any emergency medical treatment necessary and will contact me as soon as possible of any medical condition, emergency or non-emergency.

My consent must be given by phone, in writing, or in person for all trips away from the church and I will be notified of the expected return time to church or home.

The Pastor can be reached at 423-664-2765 regarding any questions.

Student’s Name:  _________________________________________

Approval by parent or guardian:  _____________________________

Date:  _________________  My Phone Number:  ________________