Carolina Beach Presbyterian Church

Activity and Medical Release Form

I, _____________________________, being the parent or legal guardian of

________________________________, do hereby grant my permission for said child(ren) to attend _____________________________ with the children’s group and chaperones of Carolina Beach Presbyterian Church of Carolina Beach, North Carolina on the date(s) of _________________.

I do also grant my permission for any emergency medical treatment to be administered in the event of an accident and do hereby release the Carolina Beach Presbyterian Church and its employees and chaperones from any liability.

Signed,

___________________________

Date: ______________________