PARENT/GUARDIAN PERMISSION SLIP FOR FIELD TRIP AND INDEMNITY AGREEMENT

PARENT/GUARDIAN PERMISSION SLIP FOR FIELD TRIP AND INDEMNITY AGREEMENT
Confirmation Retreat
FULL NAME OF STUDENT*
NAME OF PARENT/GUARDIAN*
PHONE PARENT CAN BE REACHED*
Format: (000) 000-0000.
As parent or guardian of the above named student, I give permission for my child to participate in the field trip described as follows:
PARISH/SCHOOL

St. Mary & Sons of Zebedee Parishes
DATE OF RETREAT: DURATION:

JANUARY 7, 2024 9:00 AM - 5:00 PM
DESTINATION/ACTIVITY

Shepherd of the Hills - W1562 Co Rd B, Eden, WI 53019 / Confirmation Retreat
DESIGNATED TEACHER/SUPERVISOR:

Lesa Staehler
PHONE NUMBER:

920-979-4656
MODE OF TRANSPORTATION

None Provide

Parents must make their own arrangements for transportation.
STUDENT COST

NONE, INCLUDED IN SACRAMENTAL FEES
MEDICAL INFORMATION AND RELEASE:
In the event of an emergency, I give permission to transport my child to a hospital for emergency medical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. On field trips that occur during the length of the school day. any prescription medication already provided to the school will be carried and administered by staff.

If you are unable to reach a parent/guardian at the above number, contact
ALTERNATE CONTACT NAME*
Contact Phone Number*
Format: (000) 000-0000.
PERTINENT MEDICAL CONDITIONS (PUT N/A IF NONE)*
DIETERY RESTRICTIONS (PUT N/A) IF NONE*
FIELD TRIP CONSENT AND RELEASE:
In consideration for my child/ward's participation, I agree to reimburse and indemnify the parish/school for all reasonable legal and court fees incurred by parish/school in defending a lawsuit that or my child/ward may bring against the parish/school Which relates to the above named activity if the parish/school is found not legally liable by the courts and prevails in the lawsuit. If the parish/school is found legally liable for injuries sustained by child/ward, this paragraph will not apply. Icertify that I have an understanding of this agreement and any risks and hazards associated with the activity described above that my child/ward will be participating in. I further understand that had the opportunity to fully discuss this agreement with a representative of the parish/school to clarify any concerns or questions about the activity or this agreement that may have had.
PARENT/GUARDIAN SIGNATURE*

Clear
By entering my full name, I attest that this constitutes my legal electronic signature on this form.
DATE*

MonthDayYear
Date
Please select one response. Will you allow your child to be included in an image, photograph, or video of your child to be posted or published to social media, the bulletin, newsletters, or SPIRITUS ministries by any chaperone or school personnel for this field trip.*
Should be Empty:

PARENT/GUARDIAN PERMISSION SLIP FOR FIELD TRIP AND INDEMNITY AGREEMENT

Confirmation Retreat

MEDICAL INFORMATION AND RELEASE:

FIELD TRIP CONSENT AND RELEASE: