2025-2026 Permission Slip

Student Information

Name

Full Legal Name

Birthday

Grade

Address

This address will receive a confirmation email

Phone

Does the Youth Department have permission to contact your student via text? Yes No

In Case of Emergency

Please list allergies and any conditions of which staff should be aware

Parent's Name

Parent's Phone

Parent's e-mail

Parent's Name

Parent's Phone

Parent's e-mail

Emergency Contact (other than parent)

Emergency Contact Phone

Physician's Name and Phone Number

Insurance Carrier and Policy Number

Permissions

Does St. Mark's have permission to use photos/videos online and in publications (full names are not used with photos or videos)

Does St. Mark's staff have permission to give your student over the counter medication?

(please list any preferences or exceptions)

Please check all that apply

I give my permission for St. Mark's United Methodist Church to transport my child to all youth activities that may be held off of the church premises during the 2025-2026 Ministry year. I understand that responsible adults from the church will drive my ch Should emergency medical treatment be necessary and I cannot be reached, I authorize any of the adult youth workers to act on my behalf to approve appropriate medical treatment for the listed student. I hereby release St. Mark's United Methodist Church and its representatives of any liability for emergency, injury, or death while in transport to and/or participation in a church-sponsored activity. I understand I am responsible for expenses incurred in

Digital Signature

By typing your full name below, you agree that this constitutes your electronic signature and represents your permission for St. Mark's UMC to care for your child.

Type Full Name Here

Description

Welcome to St. Mark's! We are so glad to have you as a part of our church family. Please fill out this form to register your child in our programs, and to serve as a permission form for any off campus events. If there are any changes to this information, notify the church office. Thank you!

2025-2026 Permission Slip

Description

Please Fix the Following