Student(s) (required)

Phone Number (required)

Emergency Number

I give my permission for my child to participate in the Word of Life SUPERBOWL. In the event that my child would need emergency medical treatment, I give permission for the adults in charge of the group to secure the necessary treatment to protect the life and health of my child. I understand that I will be contacted before any medical treatment is begun except where a delay in treatment would not be in the best interest of my child.

Special Medical Information

Parent/Guardian Initials and Date