Universal Permission Form

By filling out and sending in this form, you are giving permission for your student to attend any Good Shepherd sponsored event (August 1, 2023 to August 1, 2024). These events are supervised by directors of specific programming and other adults as assigned.

Transportation: Church/charter bus and parent drivers if needed. When parent drivers are used, every precaution will be used to ensure that they are properly screened, licensed, and insured. Students will be transported in cars in groups, but in special circumstances, could be the only rider in a car.

Student Name

First Name

Last Name

Parent Name

First Name

Last Name

Grade This School Year

Date of Birth

YYYY

Age

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent Email

Student Email

Emergency Contact Number

(###)

###

####

Home Phone

(###)

###

####

Emergency Care

In case of emergency, I understand that every effort will be made to contact me. In the event that I cannot be reached, I hereby give permission to the physician selected by the supervising adult to administer prescribed treatment to my child.

My child has the following allergies/health concerns (write NA if none)

My child takes the following medications (write NA if none):

I give consent to provide Tylenol, Ibuprofen, or Benedryl for my child:

My child's last tetanus shot:

YYYY