I give my son/daughter, ______________________ permission to ______________________ along with the youth group of First Southern Baptist Church on __-__-____. I also release the organization and staff of First Southern Baptist Church of any liability or claims arising from the trip. In case of emergency I give the staff permission to provide emergency medical treatment for my son/daughter. I also authorize hospital personnel to take whatever means are necessary to ensure the health and safety of my child.

Parent Signature ______________________________ Date_________________

Primary Number________________________________

Secondary Number______________________________