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Youth Permission Slip

Youth Permission Slip

I give permission for my child (named above) to attend activities, events, field trips, and service projects associated with Divine Glory Ministries, Inc. I further give permission for my child to be transported to and from events authorized by Divine Glory Ministries, Inc. in the year of 2024. I understand the organization will not be held liable for loss or damage of any personal or valuable property. I agree to ensure my child does not bring valuable or personal items to any activities or events. I understand that failure to adhere to this or any other rules established by this program will result in disciplinary action and possible suspension of my child(ren) from the program.

Have you read and understood the above statement?

Statement of Faith:

We believe that God wonderfully creates each person as male or female. These two distinct, complementary genders together reflect the image and nature of God. Rejection of ones biological gender is a rejection of the image of God within that person. We believe and will practice according to the Bible as we address children by their biological male or female assignment and name provided at birth.

Have you read and understood the above statement?

Please Initial to acknowledge you have read and accept the practices of this organization and understand this will be followed as we engage yourself and your children.

Medical Release:

In the event I am unable to be reached and my child requires immediate medical attention, the hospital/ medical care provider of my choice is:

Parent/ Legal Guardian Signature

Please upload a copy of the state issued ID's for the parents/legal guardians of the youth.

Upload Parent/Legal Guardian Photo ID

Health Care Information

Upload Parent/Legal Guardian Photo ID

Physician

Dentist

Emergency Contact

List at least two (2) people that can be contacted in the event of an emergency and you are not reachable.

Do you grant permission for your child to participate in all water related activities?
Does your child have adequate swimming experience?

A Parent/Legal Guardian/Adult must be present during the time of pick up and drop off. Children are permitted to be dropped off at an alternative address to the child’s residence to approved adults listed on permission slip. List the adults authorized to receive your child. These adults cannot be known Sex Offenders.

Is This Person a Know Sex Offender?
Is This Person a Know Sex Offender?

Please upload a copy of the state issued ID's for both adults listed above.

Upload Emergency Contact #1 Photo ID
Upload Emergency Contact #2 Photo ID

Parent/ Legal Guardian Signature

Has your child been potty trained

Due to a staffing shortage, parents must accompany children that are not potty trained to all youth activities hosted by Divine Glory Ministries, Inc.

Please initial next to the condition that applies to your child.

My child is of age and knows how to independently use the restroom. 

My child needs assistance with using the restroom and I thereby give permission for my child to be assisted in according to restroom policies and procedures of Divine Glory Ministries, Inc.

Thank you for your submission

I hereby authorize the volunteers at Divine Glory Ministries, Inc. hospitals, licensed medical or dental providers, and their agents and employees to have access to the information contained in this form and to provide simple first aid and all medical or dental care, routine tests, treatment, and necessary transportation advisable for the health and safety of my child.

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