YOUTH PIZZA NIGHT!!!
YOUTH PIZZA NIGHT!!!
What: Youth group trip to CiCi’s Pizza
When: Wednesday Night, February 8th
Where: Meet at Creek’s End the go to CiCi’s Pizza 22513 Tomball Parkway (Spring Cypress and
249)
How Much: $8 – cash or check made out to
Creek’s End
What Time: Meet at church at 630. Will be back
by 9
What Else: You will need this permission slip
filled out
How: We will take the church bus and Car pool
driven by Youth workers
What: Youth group trip to CiCi’s Pizza
When: Wednesday Night, February 8th
Where: Meet at Creek’s End the go to CiCi’s Pizza 22513 Tomball Parkway (Spring Cypress and
249)
How Much: $8 – cash or check made out to
Creek’s End
What Time: Meet at church at 630. Will be back
by 9
What Else: You will need this permission slip
filled out
How: We will take the church bus and Car pool
driven by Youth workers
Pizza Night Release Form
Pizza Night Release Form
(Please turn in with your money at the registration table)
(Please turn in with your money at the registration table)
Name: ___________________________________________________
Name: ___________________________________________________
Birthdate : ___________ School : ____________________________
Birthdate : ___________ School : ____________________________
Grade : ______________ Email : _____________________________
Grade : ______________ Email : _____________________________
Friend Who Invited You ____________________________________
Friend Who Invited You ____________________________________
Medical Info
Medical Info
Allergies : _______________________________________________
Allergies : _______________________________________________
Medications Being Taken : _________________________________
Medications Being Taken : _________________________________
Any Medical Conditions : __________________________________
Any Medical Conditions : __________________________________
Medical Ins Company : ____________________________________
Medical Ins Company : ____________________________________
Policy # : _____________________ Group # : __________________
Policy # : _____________________ Group # : __________________
Permission
Permission
I hereby release The Church at Creek’s End, their staff and
sponsors, from responsibility and liability for any injury or
illness that my child may sustain during activities sponsored
by said church. Furthermore, I authorize said churches and
sponsors, as agent for me, to consent, with regards to my
child, to ant X-RAY examination, medical, dental, or surgical
diagnosis: treatment: and hospital care advised and
supervised by a physician, surgeon or dentist (as
appropriate) licensed to practice under the laws of the state
where the services are being rendered, either at a doctor’s
office or in any hospital. I expect to be contacted as soon as
possible.
I hereby release The Church at Creek’s End, their staff and
sponsors, from responsibility and liability for any injury or
illness that my child may sustain during activities sponsored
by said church. Furthermore, I authorize said churches and
sponsors, as agent for me, to consent, with regards to my
child, to ant X-RAY examination, medical, dental, or surgical
diagnosis: treatment: and hospital care advised and
supervised by a physician, surgeon or dentist (as
appropriate) licensed to practice under the laws of the state
where the services are being rendered, either at a doctor’s
office or in any hospital. I expect to be contacted as soon as
possible.
Parent/Guardian Signature: __________________________________________
Parent/Guardian Signature: __________________________________________