Paintball November 2009 Permission Slip

Collinsville Baptist Tabernacle Permission Slip This form is to be completely filled out and signed by a parent or legal guardian before a child may participate in this event. Please Print: Parent or guardian name __________________________________________________________________ Address __________________________________________________________ Apt. No. ____________ City ______________________________________________________ Zip ________________________ Home Phone __________________________________________ Alt. Phone _______________________ Please list everyone of your household who have permission to attend Collinsville Baptist Tabernacle’s

Paintball – November 21, 2009 at 10am Name

Relationship to you

Cost: $20

Age

Date of Birth

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Do any of the above have allergic reactions to any medications? Circle one Yes No If so, please list their name(s) and the medication(s) to which they are allergic:

_____________________________________________________________________________________ Other Information: ______________________________________________________________________ _____________________________________________________________________________________ I hereby give my permission for all listed above to attend this event and participate in all activities. I understand that my child(ren) will be under adult supervision. I further understand that in signing this permission slip, I release and hold harmless Collinsville Baptist Tabernacle, its trustees, officers, employees, and any volunteers from any liability, past or future, fully and completely. I authorize the executive staff or designated medical professionals to administer emergency medical assistance if I cannot be reached. Parent or legal guardian signature _________________________________________ Date ____________