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St. Mark Lutheran Church

200 S. Wille Street
Mount Prospect, IL 60056-3121

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Pastor Christie Webb


St. Mark supports ELCA missionary Pastor Kevin Jacobson in Suriname. The $10,000 we send annually to support him is part of our benevolence dollars. We are in ministry around the world! Read More
SHINE! Permission Form
Hardcopy to print

St. Mark Lutheran Church
Youth Activity Permission Form


I give permission for my child, ________________________


To attend the following activity ________________________


Sponsored by SHINE! (the St. Mark High School Youth Group).


I am familiar with the mode of transportation, the leadership accompanying the group,

and other circumstances of the trip. 
I certify that my child is in good health and can participate in all normal activities of the group. 
Listed are any health concerns regarding my child:






I understand that reasonable measures will be taken to safeguard the health and safety of the group

and that I will be notified as soon as possible in an emergency. 

In case of sickness or accident I authorize the treatment by a qualified and licensed medical doctor

including hospitalization if necessary at my expense. 

My child is expected to abide by the rules of the trip as set by the St. Mark leaders. 

If leaders have a discipline problem with my child that they are unable to control,

I understand I will be contacted and my child will need to leave the activity at my expense.


I can be reached by phone during this activity at:



(Mother)____________________    (Father)___________________

              Phone #                                        Phone #


___________________________         ________________

Signature of Parent                                                 Date

Last Published: July 31, 2012 5:14 PM
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