PARENTAL REQUEST FOR PARISH YOUTH EVENTS

EVENT:  Wednesday Sports Competition                  COST:  FREE  - Please Bring a snack

With SMORES                                                                           or drink to share.

DATE(S):      Wednesday June 29                      TIME:  6:30-9:00 PM

                        Aug 10 (see note below)    

PARISH/SCHOOL/SPONSOR: St. Timothy

INFORMATION ABOUT MY YOUTH

NAME OF YOUTH_____________________________DATE OF BIRTH___/___/___

HOME ADDRESS_____________________________________________________

NAME OF PARENT/GUARDIAN__________________________________________

HOME PHONE (   )_____________________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:  If you plan to play outside in the Flag football, soccer or Basketball Game, GYM SHOES MUST BE WORN FOR SAFETY.

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.

Transportation: To be provided by parents. 

Parent/Guardian: _________________________________________________________Date: ____/_____/_____

(Signature)