Permission Form If you are human, leave this field blank. I, the parent/legal guardian give permission for my child(ren) to participate in any activity sponsored by Murphy Outback Youth Ministries (MOYM). I agree to hold harmless any and all persons associated with MOYM with the understanding that all reasonable safety precautions will be taken by MOYM persons during all activities and events. I agree to let my child’s photo be taken and be used appropriately by MOYM as they see fit (i.e. newsletters, publicize upcoming events, Facebook, other social media outlets, etc.). I authorize MOYM personnel to seek and obtain immediate emergency medical and/or dental treatment for my child in my absence. I understand that no matter what precautions are taken the possibility of injury is ever present. I will not hold Murphy Outback Youth Ministries, its agents, employees, or any volunteer staff liable should any damage to persons, property, illness, disease or injury result from participating in MOYM events/activities. * YES Please Enter Today's Date * Child(ren)'s First & Last Name(s) * Parent/Guardian's Full Name * Address/City/State/Zip * Primary Phone # * Email Address Emergency Contact Name * Emergency Contact Phone # * Medical Insurance Provider Policy Number Primary Doctor Name Primary Doctor Phone # Dentist Name Dentist Phone # Please list any allergies and/or medical conditions your child may have, also list any medications and/or supplements they may be taking at this time Submit
