Ladle Fellowship Permission Slip 

brooke-lark-93583 (1).jpg
Student's Name *
Student's Name
Student's Cell Phone *
Student's Cell Phone
By typing your name, you are agreeing to this permission slip by electronic means and you understand that a digital signature is the same as a written signature
Parent/Guardian Section
Mother or Primary Guardian's Name *
Mother or Primary Guardian's Name
Father or Secondary Guardian's Name *
Father or Secondary Guardian's Name
Parent/Guardian Cell Phone Number *
Parent/Guardian Cell Phone Number
Parent/Guardian Address *
Parent/Guardian Address
Emergency Contact *
Emergency Contact
Emergency Contact Phone Number *
Emergency Contact Phone Number
Parent/Guardian Permission - I give permission for my child to attend Ladle Fellowship. I hereby release and agree to hold harmless LJPC and designated leaders from all liability for damage, illness or injury to my child. In case of medical emergency, I give my permission for LJPC/SunHouse Staff and/or leaders to treat my child and make medical decisions. I give permission for my child to ride in a non-church owned vehicle driven by a volunteer. *
Media Consent - I hereby give my full consent to La Jolla Presbyterian Church (LJPC) and it's ministries to record (video, photograph, audio recording or other) my and my child's participation in any programs or events associated with LJPC. Further, I hereby transfer and assign to LJPC the exclusive rights to use and to authorize others to use said images, video, photography, audio recordings or other, for promotional and educational use or resource sale in the future. I understand that my image, voice or video recording may be used, but my name or personal information will never be shared publicly without additional, separate consent. *
SunHouse takes our responsibility to keep students safe as a top priority. Due to the recent Hepatitis A outbreak we are requiring that students we bring on this service event have had the Hepatitis A vaccination. *