Parental Consent to Participate
Please return this completed form to your youth pastor or sponsor. Be sure it includes your parent's signature, phone number, and date.
Age: ______________ Sex: M / F
City:_____________________________ State: _____________
Church Name: _______________________________________
Church City: __________________________ State: _________
Youth Pastor: ________________________________________
I hereby give permission for my child to take part in all Farmtastic Youth Rally activities
(unless otherwise indicated on back of this sheet) and absolve Farmtastic Youth Rally from
liability to me or my child because of any injury to my child while attending. In case of
medical emergency, I understand every effort will be made to contact the parents.
In the event I cannot be reached, I hereby give permission to the Farmtastic Youth Rally Nurse
to secure proper treatment for my child.
____________________________________ ____________ ________________________________________________
Signature of Parent / Legal Guardian Date Print Name of Parent
__ Check here if restrictions are listed on the
Please list a phone number where a parent can be reached on the date of the event: ____________________.