1835 E. Walnut Chatham, Illinois 62629 - 217-483-4204

Permission Slip

New Year’s Lock-In Permission Slip

 

I give my permission for _________________________________________________________

To attend the New Year’s Lock-in at Chatham Presbyterian Church, 1835 E Walnut St, Chatham, IL

On December 31st from 6 PM through 7 AM January 1st.

Comments / notes ______________________________________________________________

_____________________________________________________________________________

Signed ________________________________________                  Date_____/______/______

                                    (Parent / Guardian)

Parent / Guardian’s phone number (home) ________________________________

Parent / Guardian’s phone number (cell phone) ______________________________

Other Emergency Contact _______________________________________________