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Arcadia Chinese Baptist Church - Permission Slip

Event:  2019 Summer Retreat

Date: 6/14-6/16

Location:  Pepperdine University

每位未成年(18歲以下)參與者的家長或監護人都必須填一份  ​(譬如:若您有兩位不滿18歲孩子請填兩份)

For each participant under age of 18.


We expect each student to conform to these rules of conduct in Church-sponsored events:

No possession or use of alcohol, drugs, or tobacco

No students can drive

No fighting, weapons, fireworks, lighters, or explosives

No offensive or immodest clothing

No boys in girls’ sleeping quarters and no girls in boys’ sleeping quarters

   Participation with the group is expected                       Respect property

    Respect one another, staff, and adult leaders              Respect and comply with event schedules


Activities may include, but are not limited to: Bible studies, lock-ins, cookouts, boating, swimming, basketball, rollerskating, rollerblading, games in the park, soccer, broomball, ice skating, volleyball, softball, baseball, camping, retreats, hiking, biking, concerts, golfing, miniature golf, hayrides, joint church events, etc. Note: If you desire to limit your child’s participation in any event, please submit your wishes in writing to the church youth pastor prior to that event.


Students who fail to comply with these expectations may be sent home at their parents’ expense.


This consent form gives permission to seek whatever medical attention is deemed necessary, and releases the Church and its staff of any liability against personal losses of named child.

This minor ( name fill in below )  has my permission to attend the event sponsored by Arcadia Chinese Baptist Church:

I/We the undersigned have legal custody of the student named above, a minor, and have given our consent for him/her to attend events being organized by the Church. I/We understand that there are inherent risks involved in any ministry or athletic event, and I/we hereby release the Church, its pastors, employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my/our child’s involvement. In the event that he/she is injured and requires the attention of a doctor, I/we consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or hospital personnel designated by the Church, I/we agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I/We also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further, I/we affirm that the health insurance information provided above is accurate at this date and will, to the best of my/our knowledge, still be in force for the student named above. I/we also agree to bring my/our child home at my/our own expense should they become ill or if deemed necessary by the student ministries staff member.

By clicking "SEND"  I acknowledge , understand and further agree that I will observe and be willing to be bound by above terms and conditions.

Thanks! Message sent.

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