Maywood Evangelical Free Church

Anchored Permission Form

I, the parent or guardian of the children listed below, do hereby grant permission for these children to participate in the activities hosted on the dates listed below.

I understand that Maywood's child policies and procedures will be followed and I acknowledge that I have submitted a 2022-2023 Medical Release Form, providing information to be used in the event any medical decisions need to be made.

Date	Activity	Location
Saturday, April 29th	Movie Day	Location: Maywood Church and AMC 16 Rockford

Parent / Guardian First and Last Name

Primary Phone

Email Address

Today's Date

Emergency Phone

Emergency Contact

Child 1 First and Last Name

Child 2 First and Last Name

Child 3 First and Last Name

Anchored Permission Form

Date

Activity

Location