YOUTH ALIVE MINISTRIES of REVIVAL PENTECOSTAL TABERNACLE
1765 Pentecost Way
San Diego, California 92105

YOUTH CONVENTION PERMISSION SLIP

Dear Parents,

This permission slip shall cover the Youth Convention trip to Bakersfield, California. Please be sure to date this slip when it is signed.

“I hereby give my permission for________________________________________ to accompany the YOUTH ALIVE GROUP OF REVIVAL PENTECOSTAL TABERNACLE, to the Youth Convention in Bakersfield, California and agree to pick up said minor if any conflict situation arises. I also do hereby consent to any X-ray examinations, anesthetic, medical or surgical diagnosis as treatment and hospital service that may be rendered at the doctor’s office or at a licensed hospital. It is understood that this consent is given in advance of any specific diagnosis or treatment being required, but is given in order that said physician may have the opportunity to exercise his best judgment as to the action which may be necessary or required to protect the life and health of said minor. Furthermore, we, the said parents or guardian of said minor, do hereby agree to indemnify and hold harmless YOUTH ALIVE GROUP OF REVIVAL PENTECOSTAL TABERNACLE or its as signs against loss from any and all claims, demands or actions in law or in equity that may hereafter be made or brought by the said minor or by anyone on behalf of said minor for the purpose of enforcing a claim for damages on account of any injury incurred in consequence of an accident that may be sustained by said minor during the length of the trip.

Parent’s signature____________________________________

Date signed___________________________________________

Address_______________________________________________

_______________________________________________

Telephone___(_____)___________________________________