St. Dominic CYO Lock Out 2026 Permission Form

St. Dominic CYO Lock Out Permission Form

Parental/Guardian Consent Form and Liability Waiver
Participant's Name

First NameLast Name
Birth Date
Sex
Participant's Cell
Please enter a valid phone number.Format: (000) 000-0000.
Participant's Grade
What CYO is the participant a member of?
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mother's Name
Mother's Cell
Please enter a valid phone number.Format: (000) 000-0000.
Mother's Email
example@example.com
Father's Name
Father's Cell
Please enter a valid phone number.Format: (000) 000-0000.
Father's Email
example@example.com
I, Parent/Guardian First Name Last Name , grant permission for my child, Participant's First Name Last Name , to participate in this parish activity that may require transportation to a location away from the parish site. This activity will take place under the guidance and direction of parish employees and/or volunteers from St. Dominic Parish. A brief description of the activity follows:
- Type of event: End of Summer Lock Out
- Location(s): St. Dominic School, Deanie's Seafood, Airline Skate Center, Morning Call, Coconut Beach, Pontchartrain Racquet Club
- Individual(s) in charge: Courtney Jansen
- Duration of activity: 7 PM on Saturday, August 15 - 6:00 AM on Sunday, August 16
- Mode of transportation to and from event: School Bus
As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor (“participant”).

I confirm that there are no necessary changes to the Medical Information Consent form for my child that I previously submitted. If there are any necessary changes, I will complete another Medical Information Consent form.

I agree on behalf of myself, my child named herein, and my spouse, our heirs, successors, and assigns, to indemnify, hold harmless, and defend St. Dominic Catholic Church and The Roman Catholic Church of the Archdiocese of New Orleans, their members, directors, officers, employees, agents and representatives associated with the event arising from or in connection with the negligence and/or intentional acts of my child.
Signature
Lock Out Specific Information
Click here to acknowledge that the Lock Out ends at 6:00 AM on Sunday, August 16 and you or a designee will pick up the participant at Pontchartrain Racquet Club (5400 Irving St, Metairie, LA 70003)

My Products

Lock Out Activity Fee

No refunds can be given after August 12.

$85.00 Quantity

Total

Credit Card

Should be Empty:

St. Dominic CYO Lock Out Permission Form

Lock Out Specific Information

My Products*

Credit Card

My Products