PERMISSION SLIP   (MUST BE FILLED OUT FOR EVERY ACTIVITY)_______________________________________

Event Name: _________________________________________________  Event Date: __________________

I,____________________________________________________________ the parent and/or legal guardian of 

___________________________________________________________(said minor) born on________________________________

allow said minor to participate in the above ‘said activity’ with the NYI @ Warren First Church of the Nazarene, including

transportation if applicable, sponsored by Warren First Church of the Nazarene, a nonprofit corporation located at 4179 Parkman

Road NW, Warren, Ohio, 44481.

I recognize the possibility of physical injury associated with ‘said activity,’ and for Warren First Church of the Nazarene accepting

said minor to participate in ‘said activity,’ I hereby release, discharge, and/or other wise indemnify Warren First Church of the

Nazarene, its’ affiliated organizations, sponsors, employees, and associated personnel, against any and all claims by or on the

behalf of the minor as a result of the minor’s participation in the above referenced ‘said activity.’.

Home Phone Number (________)______________________   Work Phone Number (________)_____________________________

Emergency Contact – Name, Relationship & Phone Number _________________________________________________________

Signature of Parent or Guardian __________________________________________________________  Date _________________