Guest Pass for Friend

From the Open Files of:

NW Synod of Wisconsin Resource Center (715) 833-1153

Contributed by:

Trinity Lutheran Church, Eau Claire, WI
This file is available in Rich Text Format version for editing

TRINITY LUTHERAN CHURCH
CHILDREN'S MINISTRIES GUEST PASS
For Friends of Trinity Lutheran Church Children

PLEASE PRINT

Name of Child: Date:

Address: City & Zip:

Grade: Birth date:

Phone Number:

Father: Mother:

Emergency Name & Phone Number:

Medical Release:

 

I (We) understand that, in the event medical treatment and/or transportation is required, every effort will be made to contact me. However if, I/we cannot be reached, I/we give permission to the staff or sponsor at Trinity to secure services of a licensed physician and/or licensed paramedics to provide necessary care for my child/children's well being.

 

Parent Signature: Date:

Guest of:

Pick up Procedure:

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