Mundell Christian Church
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                                                       General Permission Slip for Youth Activities


               I,______________________, give my permission for   _____________________

                 to participate in the activities of the Mundell Christian Church youth program. I

                understand that these activities may include leaving the church property on occasion

                for fun and educational opportunities in the local area.

                     I also authorize the volunteers at Mundell Christian Church and Hospital

               personnel if needed, to administer emergency medical care to my child.





               Printed Name:           _______________________________


               Signature:                  _______________________________





               Emergency Contact Numbers:__________________________________________

                                                            __________________________________________

                                                            __________________________________________

                                                            __________________________________________




                                                       Permission Slip for Off-Site Youth Activities


               I,__________________________________________________________________

                                                                        give my permission for,

                                ____________________________________________________

                                                               to go on the Mundell Youth outing at

               __________________________________________________________________

                                                               on _________________________.

               I also give my permission for the child over which I am the guardian to receive emergency

               medical care if needed.

                           


                          Printed Name:           _______________________________


                          Signature:                  _______________________________





               Emergency Contact Numbers:__________________________________________

                                                            __________________________________________

                                                            __________________________________________

                                                            __________________________________________

Mundell Christian Church
864 Mundell Church Road
Heltonville, Indiana 47436

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