Kingdom Bound 2011 Permission Slip

I give permission for my child, ________________________________, to attend the
Kingdom Bound Festival in Darien Center, NY from July 31st, 2011 – August 4th, 2011.

Supervision and transportation will be provided by Kelly, Justin & Brianna Bricker and Micah Reitz.

I understand that if my child’s behavior is disruptive, puts themselves or others in danger, or is
otherwise deemed inappropriate by the leaders, it will be my responsibility to immediately come and pick up my child.

In case of injury requiring medical attention, I will be contacted immediately and give permission to have my child taken to the nearest hospital for treatment if necessary.

Parent Signature ________________________________________ Date _________
Student Signature _______________________________________ Date _________