Laser Tag
Sunday November 8th 3:30-6pm
Student's Name
*
First Name
Last Name
Student's Age
*
Second Student's Name (optional)
First Name
Last Name
Second Student's Age
Third Student's Name (optional)
First Name
Last Name
Third Student's Age
Consent
I grant permission for my child(ren) to attend and participate in Laser Tag (hereinafter referred to as "Activity") which will involve meeting at Resurrection Catholic Church (30W350 Army Trail Rd, Wayne, IL 60184) and carpooling to and from Lazer X (1455 W Lake St, Addison, IL 60101) on Sunday, November 8th, from 3:30-6pm.
Student Cooperation
My child agrees to abide by all the rules of aforementioned Activity and to obey the staff in charge of this Activity. The Parish, School, and Diocese will not be liable for my child's failure to cooperate and/or to abide by the rules. Any infraction of the rules may result in the immediate dismissal of my child from the Activity at my expense and without refund to me of the costs paid for the Activity.
First-Aid/Emergency Treatment
I authorize the School, Parish, and Diocese and its employees and volunteers to administer first-aid to my child if deemed necessary and appropriate to preserve the life, limb or well-being of my child. I authorize the Parish, School, and Diocese to contact and engage medical personnel and arrange for emergency treatment of my child, including transportation for medical, dental, surgical or hospital care or diagnosis, and I consent to that treatment for my child. I agree that I am financially responsible for such medical treatment
Administration of Medication
If my child needs to take prescription or non-prescription medication during this Activity, I have provided the medication in its original container. I give permission to an adult employee or adult volunteer to administer the medication or assist in the administration of the medication to my child in the dosage prescribed by the prescription or, for non-prescription medication, the dosage recommended on the container by the manufacturer. If there are explicit instructions for this medication, I state them here:
Release
I hereby release and discharge The Diocese of Joliet and its Bishop, and the Parish and School, and the officers, directors, employees, and volunteers of same, from all claims for personal injuries or property damage that I or my child may suffer while my child is attending and/or participating in the Activity, unless the injuries or damage resulted from willful misconduct of the Diocese, the Parish, the School or its employees. If I have provided medication for my child to take during this Activity, I hereby release and discharge The Diocese of Joliet and its Bishop, and the Parish and School, and the officers, directors, employees, and volunteers of same, from all claims for personal injuries or property damage that I or my child may suffer as a result of the administration of or lack of administration of or assistance in or lack of assistance in the administration of said medication to my child, whether by my child and/or an adult employee and/or an adult volunteer;unless the injuries or damage resulted from willful misconduct of the Diocese, the Parish, the School or its employees.
Parent/Guardian's Signature
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Parent/Guardian's Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent's Cell
*
-
Area Code
Phone Number
My student(s) would like to...
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join a carpool to Lazer X
drive with me to Lazer X (I'm willing to help carpool)
drive with me to Lazer X (we'll meet you there)
Click here to pay the $25 registration fee via Venmo.
I have paid the $25 registration fee online or will drop off cash or a check written out to Resurrection Catholic Church in the parish office.
*
Yes
Submit
Should be Empty: