SunHouse Permission Slip

Please make sure you select the correct form for the trip your son/daughter is attending.
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's Section
Mother's Name *
Mother's Name
Father's Name *
Father's Name
Parent's Cell Phone *
Parent's Cell Phone
Parent's Address *
Parent's Address
If the Mother's and Father's address is not the same, please put primary residential address for the student.
Emergency Contact *
Emergency Contact
Emergency Contact Phone Number *
Emergency Contact Phone Number
Parental Permission - I give permission for my child to attend the event selected above. 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. *
I would like to be added to the SunHouse email list so that I can stay informed about upcoming events and announcements.