PERMISSION FORM

Parkway Baptist Church - 12465 Olive Blvd. - St. Louis, MO 63141 - 314-434-2310

I give permission for my son/daughter, ____________________________________________,

to participate in ________________________________________, on __________   ____, 2012.

I will hold harmless any of the drivers associated with this outing.

Parent's Name (please print)

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Parent's Signature

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Phone Number

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Address

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Student's Date of Birth

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Print in Landscape Mode