Knollwood Baptist Church

800 Cheapside Street

London Ontario

Permission Form

(please print)

I _______________________________ give permission

name of parent or guardian

for ________________________________ to attend the

name of child

following event ________________________________

name of event

on the following date ____________/______/_________

month day year

Health card number is ____________________________

My address is ___________________________________

street apt#

____________________________________

city province

Home Ph# _________________________

Work Ph# _________________________

__________________________

signature