Kingsport Tennessee Ward

LDS Permission and Medical Release


This is the form for the Parent/Guardian to sign

Event Details

Event Details: Youth Activity - Cherokee Rod & Gun Club Dates of Event: October 27, 2021
Describe event and activities (please be specific): Learning the operation of firearms under the supervision of trained youth leaders at the Cherokee Rod & Gun Club.
Ward: Kingsport Ward Stake: Kingsport Tennessee Stake Event or Activity Leader's Email: bishop@ewi.ng

Participant Information

Participant: Dates of Birth: Age:
Telephone Number: Address:
Emergency Contact: Phone Number:

Medical Information and Physical Conditions That Limit Activity

Does the participant have any health conditions or special needs? Description:
Does the participant have any allergies? Description:
Does the participant require any medication during the event? Description:

 

Permission

I give permission for my child or youth to participate in the event and activities listed above (unless noted) and authorize the adult leaders supervising this event to administer emergency treatment to the abovenamed participant for any accident or illness and to act in my stead in approving necessary medical care. This authorization shall cover this event and travel to and from this event.

The participant is responsible for his or her own conduct and is aware of and agrees to abide by Church standards, camp or event safety rules, and other pertinent instructions. Participants' conduct and interactions should abide by Church standards and exemplify Christlike behavior.

Parents and participants should understand that participation in an activity is not a right but a privilege that can be revoked if they behave inappropriately or if they pose a risk to themselves or others.

Parent/Guardian Signature

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Signature Certificate
Document name: LDS Permission and Medical Release
lock iconUnique Document ID: 01485d69cafdb016e05d5e26c56c095b94d9a5f0
Timestamp Audit
October 19, 2021 2:30 pm ESTLDS Permission and Medical Release Uploaded by Kingsport Ward - hello@kptward.com IP 47.40.253.97