First Baptist Church
350 HWY 96 S
Silsbee, TX  77656

Parental Consent Form for Day Trips

Name                                        Age                                          Birth Date                                        

Street Address                            City                                          State                                                

Zip Code                                                           Phone                                                                      

School                                                               Grade Level                                                             

Parent(s) Business Phone                                                                                                                     

To whom it may concern:

I (we) hereby give permission for my (our) child, (print name of child) ______________________, to attend and participate in activities sponsored by First Baptist Church, Silsbee on April 26, 2009.

Participant                                                                                              Date                                    

Parent/Legal Guardian                                                                            Date                                    

On the reverse side of this page, please list any allergies or special medical problems your child may have.