PERMISSION SLIP

Date _____________________________

I, ______________________ (PRINT) AM THE PARENT OR GUARDIAN OF __________________________ (PRINT) A CHILD UNDER THE AGE OF 18 AND OVER THE AGE OF 16.  HE/SHE IS A MEMBER OF THE _____________________ FIRE DEPARTMENT OR RESCUE SQUAD.  HE/SHE HAS MY PERMISSION TO PARTICIPATE IN THE NORTHERN PANHANDLE FIRE SCHOOL ON APRIL 30 & MAY 1 2011

SIGNED ______________________

 INSURANCE

____________________________  IS COVERED UNDER THE INSURANCE OF THE ______________________  FIRE DEPARTMENT/RESCUE SQUAD.

SIGNED _____________________

FIRE CHIEF OR FINANCIAL OFFICER