Permission Slips & Forms
Please read this entire page before selecting a Permission Form.
For what activities does my student need a Permission Form?
Any Houghton Wesleyan Church sponsored event where students (minors) are driven in a vehicle by anyone other than their own parents or legal guardians (like in a carpool) requires that a Permission Form be completed and signed by the student’s parent or guardian.
What is the purpose of the Permission Form?
There are two different types of Forms, the Annual Permission Form and the Single Event Permission Form; both allow students to participate in a HWCYG event, and in the event of a medical emergency, allow the sponsors, leaders, volunteers, or adult chaperones of a HWCYG event to administer first aid and/or transport the individual to the nearest doctor or hospital for further medical attention. The Permission Form is for your student’s safety! Without it, a doctor will not give them medical attention, unless the injury is immediately life threatening. It also releases Houghton Wesleyan Church, its paid staff, and any volunteers helping out, from legal liabilities in the unforeseen event of a health or safety issue involving your son or daughter.
Parents are responsible for ensuring that Houghton Weslyan Church has the most current information regarding their son or daughter.
A new Annual Permission Form is required if, at any time, there are any changes to the following:
Health Insurance Carrier
Policy Number
Date of Last Tetanus Injection
Current Medications
Special Medical Instructions
Emergency Contacts
If you are okay with the risk, please select one of the two Permission Forms available for your use.
This document should be filled out once per school year and used throughout the entire school year for all events requiring a Permission Form. Please note the expiration date on the form; you’ll need to fill out a new form BEFORE or AS SOON AS the current one expires.
It will save you time because you’ll only fill it out once for the whole school year.
It will be kept on file in the Student Ministries office and will be used if a problem or an accident occurs.
Please submit a 2011-2012 Annual Permission Form today if your son or daughter regularly attends HWCYG functions.
PLEASE NOTE: If any of your information changes, we will need an updated form so that your child is assured of proper treatment, should the need arise.
2. Single Event Permission Form
This document should be filled out once per each event that requires a Permission Form and used only for that event.
This document is used by students who don’t participate in HWCYG events on a regular basis.It will expire immediately after the event it was used for.
A new Permission Form will be needed for your student to participate in another HWCYG event.
Single Event Permission Form
Additional Notes:
Occasionally, an organization or facility will require their own Release of Liability Form.
Students desiring to participate in an event that requires a Permission Form and/or release form must submit a completed one before they can participate.
Please mail your completed Permission Form to:
Houghton Wesleyan Church
Youth Group
P.O. Box 127
Houghton, NY, 14744
Or fax to:
(585) 567-4418
Email to:
Questions? Call Pastor Jon at 585-567-2264.