89F69E9EC19D4706B3AB42AF24A06918 Harambee Off Site Permission Form

Off-site Activities Permission Form Student’s Name:_____________________________________________________

Church Affiliation:___________________________________________________

Parent or Guardian’s Name: __________________________________________ Print

`

Phone

The student has provided appropriate insurance information: ____ Yes or ___No

This student has permission to participate in an off- site activity with the SEJBMCR Youth Harambee Group.

_________________________________________ Parent or Guardian Signature

_______________________________________________ Chaperone’s Name & Signature

__________________ Date

_______________ Date