PERMISSION TO ATTEND EVENT     

I, ____________________________ (parent or guardian) do hereby give permission for

 ____________________________ (child’s name)

to attend _______________________________ sponsored by the Idaho Falls First Church of the Nazarene

on          /          /           to          /          /          .  (date of event)

PERMISSION TO OBTAIN MEDICAL TREATMENT

  I do hereby grant permission for __________________________

or ___________________________, appointed agents of Idaho Falls First Church of the Nazarene, to act on my behalf to obtain medical treatment for my child if injured or ill from any licensed physician, nurse or E.M.T.  In signing this form, I release Idaho Falls First Church of the Nazarene, its staff, its appointed agents and medical personnel from any liability.

SIGNED                                                                                                          

DATE ______/______/______

Parent’s Phone Number (           )              -                    (home)

(           )              -                    (work)

 Family Doctor:  Name                                        Phone:  (          )            -                                             

Insurance Co.                                                   

Policy Number                                                            

Date of last Tetanus Shot (if known)  /            /           Blood Type                            

Any known allergies                                                                                       

Current Medications                                                                                       

Other medical conditions or treatment:  (please list)