Birch Bay
Water Slide Day!
(grades 7-12) $3 sign up fee to reserve spot!
WHERE:
Birch Bay Water Park
-Water Slide Cost: $13
WHAT:
Water slides, lunch, fellowship!
-lunch & dinner money too!
WHEN:
Saturday August 29th
-Time: 9:00am-7:00pm
Bring:
Modest Swim Wear, towel
-Pick Up at 7:00pm @ YH!
Permission Slip/ Medical Release Form
I hereby agree to follow all rules and guidelines set before me on this youth trip. I will listen to
and respect my leaders, my peers, and myself.
Student Name (printed)
Grade:
Address:
Student Signature
Date
I hereby give permission for the above youth to participate in a Ignition Fun Day mentioned
above. I understand that the group will have adult supervision and be involved in various land activities.
I give permission for my youth to receive emergency medical treatment including anesthesia,
should the need arise. However, in the event of an accident of illness, I understand that every reasonable
effort will be made to contact the parent/guardian immediately.
Please list any allergies your child may have to medications or any current medical conditions he/she
may have. ______________________________________________________________________________
______________________________________________________________________________
Print Guardian Name
Phone #
Signed Legal Guardian
Date
Emergency Contact
Emergency #
His Place Youth Ministry
1480 S. Burlington Blvd. | Burlington, WA. 98233
Youth House #: 360.757.8961 | Fax #: 360.757.7381
www.hisplaceyouth.com |