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Middle School Permission Slip - VBS 2023

Event giving permission for

Please make sure you select the correct form for the trip your son/daughter is attending.

Student's Name

First Name

Last Name

Gender

Grade

Student's Cell Phone

(###)

###

####

Student Agreement - I understand that I will be sent home at my parent’s expense if I: Bring any drugs, alcohol, or weapons, display any violent or disrespectful behavior, or fail to follow instructions by all SunHouse leaders. I agree that if I take my cell phone or other electronic device with me on this event, I assume all responsibility for broken, damaged, lost or stolen items.

By typing your name, you are agreeing to this permission slip by electronic means and you understand that a digital signature is the same as a written signature

Parent's Section

Mother's Name

First Name

Last Name

Father's Name

First Name

Last Name

Parent Email

Parent's Cell Phone

(###)

###

####

Parent Cell Phone

Parent's Address

If the Mother's and Father's address is not the same, please put primary residential address for the student.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact

First Name

Last Name

Emergency Contact Relationship

Emergency Contact Phone Number

(###)

###

####

Parental Permission - I give permission for my child to attend the event selected above. I hereby release and agree to hold harmless LJPC and designated leaders from all liability for damage, illness or injury to my child. In case of medical emergency, I give my permission for LJPC/SunHouse Staff and/or leaders to treat my child and make medical decisions. I give permission for my child to ride in a non-church owned vehicle driven by a volunteer.

Yes.

Digital Signature - I have agreed to submit this permission slip by electronic means. By signing this permission slip electronically, I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.

Media Consent - I hereby give my full consent to La Jolla Presbyterian Church (LJPC) and it's ministries to record (video, photograph, audio recording or other) my and my child's participation in any programs or events associated with LJPC. Further, I hereby transfer and assign to LJPC the exclusive rights to use and to authorize others to use said images, video, photography, audio recordings or other, for promotional and educational use or resource sale in the future. I understand that my image, voice or video recording may be used, but my name or personal information will never be shared publicly without additional, separate consent.

Yes.

I would like to be added to the SunHouse email list so that I can stay informed about upcoming events and announcements.

Yes