St. Timothy Catholic Church, Permission slip

PARENTAL REQUEST FOR PARISH YOUTH EVENTS

DEADLINE FOR PERMISION SLIP & MONEY – Wed AUGUST 24

EVENT: ROCK THE UNIVERSE COST: $65 includes Universal Park entrance, charter bus, parking and refreshment at Shrine

DATE(S): Sept. 10-11, 2011 TIME: 1 PM on Sept. 10 thru 2 AM Sept. 11

PARISH/SCHOOL/SPONSOR: St. Timothy & St. Mark Youth Ministry

INFORMATION ABOUT MY YOUTH

NAME OF YOUTH_____________________________DATE OF BIRTH___/___/___

HOME ADDRESS_____________________________________________________

NAME OF PARENT/GUARDIAN__________________________________________

Teen and parent’s

Parent’s email ________________________CELL PHONE ( _)_________________

MEDICAL INFORMATION: Please list all information pertaining to allergies, diet, special medication, health conditions or any other information necessary in an emergency situation. Explain fully.___________________________________________________________

_____________________________________________________________________

PLEASE NOTE: We will have early admission to the park. You must provide your own transportation to and from St. Timothy Catholic Church. A soft drink will be provided for at the Shrine, but a sandwich AND money to eat at the park is recommended. Wear comfortable shoes. Parents MUST be ready to pick up youth by 2 AM at St. Timothy’s.

CONSENT AND RELEASE

General: I hereby request and give my permission for my youth to participate in the above event. I understand and assume the risks inherent with this event from other parties, but I also understand that all reasonable care and supervision will be exercised to provide for the general well-being of my youth. I, individually and on behalf of my youth named below, do hereby release, covenant not to sue, and save harmless: The Most Rev. Robert N. Lynch, Bishop of the Diocese of St. Petersburg; the above parish/School; and all employees, agents and volunteers for the event, from any and all claims for any and all harm arising to my youth as a result of their participation in this event.

Medical: I request the Parish/School representative obtain medical treatment for my youth in the unlikely event of injury or illness during this event and I agree to pay any expenses incurred for such treatment.

REQUEST FOR TRANSPORTATION

___________ My son/daughter has permission to ride the Church/Charter bus for this event.

Parent/Guardian__________________________________________________Date____/_____/___