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The Clerk's Office Digital Forms

Fill Out Permission Slip

Use this tool to fill out a permission slip. You can do so without registering. When you submit your form, a PDF of your permission slip will be emailed to you and your event leader. If you log in, you can save participant information to automatically populate the form.

Find using Leader-supplied Form Code:

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Click to see/fill a sample form.

Complete and submit the form once for each participant.

The
Clerk's Office
PERMISSION-SLIP

Permission and Medical Release Form Filler

Complete this form separately for each event or activity involving special considerations (see Handbook 2: Administering the Church, 13.6.20, ChurchofJesusChrist.org), an overnight stay, travel outside the local area, or an activity with higher than ordinary risks. Event leader should have access to all forms during the event.
Event Details (to be filled out by event planner)
Event
Date(s) of event
Describe event and activities (please be specific)
Ward
Stake
Event or activity leader
Event or activity leader’s phone number
Event or activity leader’s email
Participant Information
Participant *
Date of birth *
Age *
Telephone Number *
Address *
City *
State or province *
Emergency contact (parent or guardian) *
Primary telephone number *
Secondary telephone number
Medical Information
Does the participant require a special diet? *
If yes, please explain the dietary restrictions
Does the participant have any allergies? *
If yes, please list the allergies
List all prescription or over-the-counter (OTC) medications the participant is taking. Leave Blank if none.
Can the participant self-administer his or her medication?
If no, please contact the event or activity leader directly.
Physical Conditions That Limit Activity
Does the participant have a chronic or recurring illness? *
If yes, please explain
Has the participant had surgery or a serious illness in the past year? *
If yes, please explain
Identify any other limits, restrictions, or disabilities that could prevent the participant from fully participating in the event or activity (attach additional pages if needed)
Other Accommodations or Special Needs
Identify any other needs or considerations the participant has that the event or activity planner should be aware of (attach additional pages if needed)
Permission

I give permission for my child or youth (or if signing on my own behalf, as a leader attending this activity, I personally consent) to participate in the event and activities listed above (unless noted) and authorize the adult leaders supervising this event to administer emergency treatment to the above-named participant for any accident or illness and to act in my stead in approving necessary medical care. This authorization shall cover this event and travel to and from this event.

Please Note: Units may not have the ability to meet all medical, physical, and other accommodations and are asked to counsel with parents or guardians on what is possible.

The participant is responsible for his or her own conduct and is aware of and

agrees to abide by Church standards, camp or event safety rules, and other pertinent instructions. The participant’s conduct and interactions should abide by Church standards and exemplify Christlike behavior, including those listed on the attached “Conduct at Church Activities.”

Parents and participants should understand that participation in an activity is not a right but a privilege that can be revoked if participants behave inappropriately or if they pose a risk to themselves or others.

This information is collected to help event and activity leaders or medical personnel so they can be prepared and appropriately respond to health concerns or an emergency. It will be kept confidential and shared only as needed.

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Got this form from theclerksoffice.com
When you submit this form a pdf copy will be sent to your Email as well as the leader of the Activity. Email me if you have any questions.

Complete and submit the form once for each participant. Clear Form

I'd Rather do a Paper Copy Please contact the event leader and let him/her know. Print, fill, return your form to the activity leader.