Youth Group Field Trip Permission Form

Names of Child(ren)

Parent or Guardian Name

First Name

Last Name

Phone

(###)

###

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Additional Parent/ Guardian Name

First Name

Last Name

Phone

(###)

###

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Please list allergies or special needs

Please list any dietary restrictions

General Permission: My child(ren) has(have) permission to participate in church, church school, youth group, or related programs in St. Stephen’s Episcopal Church. I take full responsibility for my child(ren) in the event of an illness, accident, or injury. I will hold no members, paid staff, or volunteers of St. Stephen’s Episcopal Church responsible or liable in the event of illness, accident or injury. I further give the paid or volunteer staff of St. Stephen’s permission to seek medical treatment for my above-named child(ren) in the event that it is deemed necessary.

Please type your full name to indicate your signature

Travel permission: I give permission for my child(ren) to be driven from St. Stephen's to the location of a field trip.

Please type tour fill name to indicate your signature

Photography permission (optional): I grant to St. Stephen’s Episcopal Church the right to take photographs of my child(ren). I authorize St. Stephen’s Episcopal Church and its agents to copyright, use and publish the same in print and/or electronically. I agree that St. Stephen’s Episcopal Church may use such photographs without my child(ren’s) name and for any lawful purpose, including publicity, illustration, advertising and Web content.

Please type your full name to indicate your signature