ROYAL RANGERS

Information & Permission Slip

Activity: _________________________________________________________

Location: _________________________________________________________

Depart: _________________________________________________________

Return: _________________________________________________________

Costs: _________________________________________________________

What to Bring: _____________________________________________________

Other Instructions: _________________________________________________

Emergency Contact #: _______________________________________________

Retain the above part of the form for your information about the activity.

Detach the portion below and return with money to the Royal Rangers.

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Royal Rangers Permission Slip

While striving to ensure a wholesome, safe, and closely supervised environment for boys in its care the National, Regional, District, Sectional, Area, or Outpost Royal Rangers cannot be held liable for any unforeseen and unforeseeable accidents or injuries which may occur during the course of any Royal Rangers activity.

Responsible leaders, persons, and acting agents transporting boys on behalf of the Royal Rangers ministry of the Assemblies of God assume no personal liability in case of accident or sickness. My signature below gives permission for my boy to ride in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in activities sponsored by the Royal Rangers.

As part of the Royal Rangers program, the _____________________________ activity is planned to take place at (location)____________________________________.

I hereby consent to allow my boy to attend and participate in the above listed activity. In the event of an accident or emergency, I, the parent of (child’s name)______________________, give permission for him to have emergency treatment performed by any first aid station, EMS, hospital, or emergency care center.

________________________________ ________________

(Signature of Parent or Guardian) (Date)

Revised: September 2005