Permission Slips Youth Ministry Permission Forms _____________________________________________________________________________ Name                                                                                               Age _____________________________________________________________________________________ Address                                                                         City     State      Zip   Phone Number _____________________________________________________________________________________ School              Grade                                             Birthdate     E-Mail Permission I/we, the parents or guardians of the above-mentioned child, for myself, ourselves and for my/our child, give permission for my/our child to participate in the ___________________________________________________ activity for the date of _______________________________________in the year________________________. Medical Authorization In the event of any injury or illness to my/our child during his/her participation in this event, I/we hereby give my/our permission for the necessary medical treatment to be given to my/our child. I/we agree that in case of injury to my/our child, I/we will apply my/our hospitalization and/or accident insurance toward the payment of the expenses incurred and will not look to St. Maurice Parish, or the Roman Catholic Dioceses of Pittsburgh for the payment of any medical costs or injury related costs. __________________________________________________________________________________________ Parent/Guardian Signature                                                       Parent/Guardian Phone Number ________________________________________________________________________________________ Insurance Company                                                                                          Policy Number   __________________________________________________________________________ Name and Phone Number of Person if parent/guardian is not available.