RE Visitor Permission Form

Caregiver Name *

First

Last

Phone *

Email *

Permission *

By checking this box, I agree to give permission for the child(ren) listed below, for whom I have legal authority, to participate in First Unitarian Universalist Church of Columbus (First UU) programming and/or childcare. I understand that I may not leave the First UU premises without returning the child(ren) listed below into my care. I further release First UU and/or its representatives from any and all responsibility or liability of any nature whatsoever for any loss or damage to person or property that may occur during said programming and/or childcare.

Date *

If there is urgent information such as an allergy or participation complications please inform the teacher/childcare provider as well.

How Many Participants?

Selected Value: 1

1. Name & Age *

Is there any information about participant #1 that might be helpful?

2. Name & Age *

helpful? 2. participant

Is there any information about participant #2 that might be helpful?

3. Name & Age *

Is there any information about participant #3 that might be helpful?

4. Name & Age *

Is there any information about participant #4 that might be helpful?

5. Name & Age *

Is there any information about participant #5 that might be helpful?

6. Name & Age *

Is there any information about participant #6 that might be helpful?

First Unitarian Universalist Church