^.Permission to Attend Activities

I hereby grant permission for my son/daughter _______________________________________,

to attend activities sponsored by Bethel Assembly of God, Interlachen, FL. (386) 684-6178.

This includes permission to transport my son/daughter to and from such activity. I understand these

activities will be chaperoned by an adult sponsor of United by ONE Youth Group under the
leadership of Marty Albanese.

I understand that in the event that medical treatment is required, every effort will be made to contact me.

However, if I cannot be reached, I give permission to the staff to secure the services of a licensed

physician to provide the necessary cares, including anesthesia, fo my child's well being.

______________________________________________________________________________

On ___________________ we will be going to ______________________________________

                                      ^{Date                                                                                                                                                                          City/State}

to _________________________________________________________. We will be leaving

                                                   ^Activity

the Church at ___________, try and be there by ______________, we will return to the Church

                                                   ^{Time Leaving                                                                               Time to be at Church}

at ___________________. Please pick your son/daughter up at the Church at _______________.

                          ^{Time we will Return                                                                                                                                                                              Time to Pick up son/daughter}

Please Bring food money and any spending money that you need.

____________________________________________________

Parent's Printed Name

____________________________________________________

Parents Signature

Phone Number:_______________________________

Date: ___________________