CAMP SPRINGS COMMUNITY CHURCH (CSCC)

8040 WOODYARD ROAD

CLINTON, MD 20735

Telephone (301) 868-3030

FAX (301) 868-0897

Permission Slip & Medical Release Form

My son/daughter will be attending the CSCC youth activity:

Teen All-Dayer

Return this slip by:

January 3, 2009

Date Of Departure

January 3, 2009

Date Of Return

Time Of Departure

10:00 am

Time Of Return

9:00 pm

Location

CSCC

8040 WOODYARD ROAD

CLINTON, MD 20735

Telephone (301) 868-3030

Cost

 N/C

Transportation

A.  Church-owned van

B.   Commercial      __________________________________________________________________

C.  Other (Specify) __________________________________________________________________

Notes

Bring this permission slip SIGNED by the day of the Teen All-Dayer. Kids will not be allowed to attend without a permission slip completely filled out and signed by your parent or legal guardian.

 PLEASE FILL OUT THE BACK COMPLETELY

I (We), the undersigned parent, parents or legal guardian of the below listed minor understand the nature of the church activity in which my son/daughter will be participating and that he/she is expected to abide by all Camp Springs Community Church (CSCC) Youth Group rules during the course of the activity listed above. Furthermore, I (We) understand that if my son/daughter does not abide by the rules, that I (We) may be asked to pick-up my son/daughter at the location listed above or at the church.

I (We), the undersigned parent, parents or legal guardian of the below listed minor understand that Camp Springs Community Church is responsible for the conduct or safety of my son/daughter only while he/she is or should be under the immediate and direct supervision of a chaperon of Camp Springs Community Church. 

I (We), the undersigned parent, parents or legal guardian of the below listed minor, do hereby authorize and consent  for Camp Springs Community Church chaperons to act on my behalf, in the event of an accident, illness or any other circumstance requiring medical treatment until such time that I can be contacted.  Furthermore, such treatment may be procured for my son/daughter without financial obligation to the church or chaperones.

I (We), the parent, parents or legal guardian of

CHILDS NAME (FIRST MI. LAST)

hereby give my permission for him/her to participate in the activity described on page 1 of this document_

Enclosed is

$              .

to cover the expenses of the trip.
(Checks made payable to Camp Springs Community Church.)