Student Ministry Permission Form Parent/Legal Guardian's Name*I give permission for my child to take part in this activity First Last Child/Youth's Image Consent*I hereby grant/do not grant permission for my child's/children's) image to be included in pictures, videos, promotional materials, and publications connected with South River Baptist Church. I grant permission I do not grant permission Child/Youth's Name* First Last Activity Name* Sponsored by South River Baptist Church on this date.Activity Date* MM slash DD slash YYYY Emergency Contact Name* First Last Emergency Contact Phone*Parent/Legal Guardian Signature (typed name)* I am fully aware that there will be ample supervision for this event. I have completed and witnessed the notorization of a Medical/Liability Release Form for my child. By signing (typing in your name) this permission slip, I am confirming that the information on his/her Medical/Liability Release Form is current and up to date. I understand in the unlikely event of an accident or emergency that my child will receive adequate care based upon the information given.Email* Enter Email Confirm Email Date* MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged. 2659 S. Chipley Ford Rd. Statesville, NC 28625 704-876-1520 southriverbaptist.com Share this:TweetLike this:Like Loading...