Youth Permission Slip

Event Name*
Child's Name*
First Last
Child's Name (2)
First Last
Child's Name (3)
First Last
Photo Publication*
- I give COSLC permission to use my child's photo for publication
- I do not give COSLC permission to use my child's photo for publication
Parent Name*
First Last
Parent Name (2)
First Last
Parent's E-mail
Parent's Phone*
Food Allergies*
Please list all FOOD allergies for each child. If your child/children are allergy free, just type 'NONE'
Medication Allergies*
Please list all MEDICATION allergies for each child. If your child/children are allergy free, just type 'NONE'
Medical Concerns/Restrictions*
Please list all MEDICAL CONCERNS/RESTRICTIONS for each child. If your child/children has none, just type 'NONE'
Emergency Contact*
First Last
Emergency Contact Phone*
Upload a picture of your insurance card*
Accepted file types: jpg, gif, png, pdf, Max. file size: 64 MB.
I here by grant permission for the leaders of Christ Our Savior Lutheran Church to seek emergency care for my child*
- I agree
Untitled
- First Choice
- Second Choice
- Third Choice