Parental Permission Form

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Parental Permission Form Redeemer Presbyterian Church Jr. & Sr. High Student Ministry 1166 Avenue of the Americas, 16th Floor ,New York, New York 10036 212-808-4460 As a parent or guardian, I give permission for: To participate in the following activity or event: At this time and date: Parent/Guardian Name: Home Phone: Work Phone: Address: City/State/Zip: Additional Emergency Phone Number: Signature of Parent/Guardian: Relationship to Participant: Special needs or requirements of Participant(s): (PLEASE NOTE: YOUTH LEADERS MAY NOT ADMINISTER MEDICATION!)