PERMISSION SLIP / EMERGENCY FORM Please complete this form that will accompany your child for the '23-'24 season. This information is necessary should we need to contact you. No student will be allowed to attend without this form being completed and signed by the parent or legal guardian. The information on this form is considered confidential.

Please provide the information requested below, as it may be needed in case of an emergency. This information does not modify the information on the emergency card.

If different from above.

If different from above.

I hereby authorize the release of my child’s pertinent medical information to the appropriate professional staff. I give permission to the physician or hospital to secure treatment for him/her and to order medications, injections, anesthesia, or surgery for my child, as named above, in case of emergency. The signature below constitutes authorization to perform any necessary treatment for my child during this field trip.

At times it becomes necessary to use private vehicles or the church-owned van to transport students to and from Burr Oak Baptist Church children/youth activities. When this occurs, Burr Oak Baptist Church requires that a parent/guardian of the student sign the Transportation Release Consent Form. This form operates as general consent for the transportation of students to and from church connected activities. By signing this form, I hereby release Burr Oak Baptist Church, as well as its directors, coordinators, employees, or other agents from all liability or damages for any and all injuries arising from the negligence of any of the above while traveling to an activity via private vehicle or church van.