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:

                                                                         Fall 2000