I give permission for my child,_________________________, to participate in the First UMC Student Ministry Retreat to  ________________________. In the event of an emergency, I give my permission to Jim Moon III, Associate Pastor, or an adult chaperone of First United Methodist Church to obtain and secure any needed medical attention.

____________________________________________________ _________________________

                                      Parents’ Signature                                                 Date

In case of an emergency, I can be contacted in the following manner:

_______________________________________________________________________________________

If I cannot be reached, please contact this person in an emergency:

__________________________________________________ _________________________

                                     Name                                                                  Phone