SLiM’s

A week of your summer spent making

a difference in the lives of people in high school ministry
inner-city Memphis, TN. This years trip
will focus on helping tackle the issue Cost: $200 early bird
of poverty in Memphis. We will be ($225 after June 21st)
assisting with building projects, and as
always working with cute little Deposit: $50 + this form
kids. We’ll take Friday off to
see some of the sights, taste
Due: June 21st
some of the BBQ and listen
to some of the bluesy Who: high school only
jazziness. (incoming freshman through
outgoing seniors)

photos / downloads / forms / info - cravememphis.slimwired.com

I, ________________________________(parent/guardian), give permission for _________________________________(student)

to take part in Mission: Memphis including, but not limited to transportation and activities, on July 11-18, 2008. I understand the nature of
the event and do hereby release Mount Pleasant Community Church, its employees, staff and volunteers from all liability or claims arising
from or related to the event. In the event of an emergency, I hereby authorize an adult leader of this activity, as an agent for me, to consent
to any X-ray examination; medical, dental or surgical diagnosis; treatment; and or hospital care advised and supervised by a physician,
surgeon or dentist (as appropriate) licensed to practice under the laws of the state where the services are rendered, either at a doctor’s
office or in any hospital. I expect to be contacted as soon as possible.

Home Phone: _________________________ Mobile Phone (parent): _________________________

Address: ___________________________________________________________ Class of 20_____

Parent/Guardian Signature: ____________________________________________ Date: ____________

Office use only: Deposit Cash Check # Balance