Permission Slip 5

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PERMISSION SLIP As a parent/legal guardian of

, I have reviewed the information

about the Gunpowder Falls State Park Wildlands Loop, and give permission for my son/daughter to be involved in the hiking trip. The trip will take place from Sunday Sept 13th 2015. I hereby agree that my son/daughter will abide by the rules of Sovereign Army especially during this trip. I also acknowledge that failure to abide by these rules may lead to returning my son/daughter back early for discipline violations and at my own expense. I understand all reasonable safety precautions will be taken at all times by Sovereign Army leaders during this activity, including the drive to and from the trip. I authorize any treatment by an accredited hospital and/or physician deemed necessary for my son/daughter in case of an emergency. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold Jesus House Baltimore and Sovereign Army leaders, liable for damages, losses, diseases, or injuries incurred by the my son/daughter. The trip will include activities such as hiking and about 2-4 miles will be covered. Sovereign Army rules: Respect leaders, other youth, and God. Specific trip rule: Follow trip rules. Each adult leader can set additional guidelines for their assigned son/daughters. Teen: “I agree to follow these rules, understanding that the consequences of not doing so include instant dismissal and the inability to attend future trips” Teen signature: _____________________________________________ Parent signature: _____________________________________________ Parent emergency contact #: _________________________________________ Insurance company and policy: ______________________________________________________________________________ Pertinent allergies/medical conditions: ______________________________________________________________________________ ______________________________________________________________________________

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