Author: rose

Springview Community Church
Parental Permission and Hold Harmless Agreement

Name of Child(ren)
Address
Phone
Email
Birth date(s)

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

I hereby give my permission for my child(ren) to attend Springview Community Church activities and programs on this date ___________. This permission cover events at the church as well as events that require leaving the facilities during the stated time period.
I agree to hold Springview Community Church harmless in case of an accident or injury while my child is participating in the church’s activities. I understand that all normal care, supervision and safety will be exercised on behalf of my child while in attendance.

Parent/Guardian
Address (if different)
Phone

____________________________________________________________________________________________________________________________________________________________

Emergency Contact
Emergency Phone
Relationship to child

____________________________________________________________________________________________________________________________________________________________

Please list any health concerns we should be aware of: _______________________________________________________________________________________________________________________________________

Parent/Guardian Signature
Date

_______________________________________________
_______________________________________________

Www.springviewcc.org