Cairo Church of God

Madison Church of God 771 N.E. Colin Kelly Rd. Madison FL. 32340 850-973-3339 Permission Slip for travel with Blood Line Youth Ministry

Upon signing this form I agree to the following: A. I am giving my child permission to travel with Blood Line Student Ministries / Madison Church of God. B. I understand that there will be at least one chaperon for every six children under the age of 18 on all trips. C. I understand that the success of any trip is determined by the Attitudes and actions of each person and that if my child becomes disruptive, and every other action that could be taken has been, then I may be held responsible for any expenses in getting my child home from the trip. D. I understand that there will be a deadline for trips/church functions and that after that deadline is met any money that has been given cannot be reimbursed unless for a medical or family emergency and that if I remove my child from any trip/church function after the deadline I may be responsible for any money that the church had to pay for hotel rooms, tickets, registration, or any other item that the church cannot get back. E. By signing this form I am releasing Blood Line Youth Ministry / Madison Church of God from any liabilities that may be encountered on this trip. F. In the event of an emergency, someone from the church will contact me at the phone number I have provided in the information area of this form. In the event that I cannot be contacted at the number I have provided, the person/s in charge from Madison Church of God have my permission to seek medical attention for my child at the nearest medical facility to their location at the time of the emergency. I understand that I am responsible for all medical expenses concerning my child.

Signature of Parent or Legal Guardian: Date:

Notary Seal: Signature of Notary:

Pastor Doyle Glass 850-869-0051 Student Pastor Avery Hutto 850- 464-8885