PARENTAL PERMISSION FORM: PART I

FIRST CHURCH OF THE NAZARENE
Seymour, Indiana

CHURCH POLICY STATEMENT:  Children and/or teenagers participating in church activities which    involve traveling extensively, traveling outside the Seymour area, or being away from home overnight are to be provided with a "Parental Permission Form" which must be signed and returned to the leader of the sponsoring class or church organization BEFORE the activity.  The use of the "Parental Permission Form" represents a good‑faith effort on the part of the church to keep parents and guardians fully informed and to provide proper care for their children and/or teenagers.

 INFORMATION FOR THE PARENT OR GUARDIAN TO KEEP:

1.  Type of activity:_____________________________________________________________________

2.  Time and place of activity: ____________________________________________________________

3.  What the child/teen will need:__________________________________________________________

    __________________________________________________________________________________

4.  Mode of transportation:_______________________________________________________________

5.  In the event of an emergency which makes it necessary to contact a child or teen while the group is away, parents may contact the church office, (812)522-2060.

6.  The information above, and any additional information about the activity, is provided by the individual in charge of the group:
                                               _________________________________       __________________
                                                       Name of Activity Leader                       Telephone Number

THE INFORMATION ABOVE IS TO BE COMPLETED BY THE ACTIVITY
LEADER AND GIVEN TO THE PARENTS
______________________________________________________________________________

THE PORTION BELOW IS TO BE COMPLETED BY THE PARENTS
AND RETURNED TO THE ACTIVITY LEADER
(This form is to be in the possession of the activity leader during the activity.)

PARENTAL PERMISSION FORM:  PART II

FIRST CHURCH OF THE NAZARENE
Seymour, Indiana

________________________________  (name of participant) has my permission to participate in

 ______________________________________    (name of activity) sponsored by the First Church of the Nazarene in Seymour, Indiana.  I have read the accompanying information about the activity.  In the event

 of an emergency, I may be reached at _________________ (home phone) or _________________ (work phone).  I grant my permission for emergency medical treatment to be administered if such treatment becomes necessary and I cannot be reached.

                 ________________                 _________________________________________ 
                          DATE                                  SIGNATURE OF PARENT OR GUARDIAN