The following are a few rules that all participants are expected to follow while participating and representing

 
__________________________________________________________________________________________

^{Name of Parish/School/Area Faith Community (AFC)}

 
In this event sponsored by____________________________________________________________________

^{Name of Parish/School/AFC}

 
On_______________________________________________________________________________________

^{Date of Event}

 
Please read and sign.

 

I, _______________________________________________________, WILL:

                                    ^{Printed Name of Youth Participant}

• Treat all other persons with respect and not cause any intentional harm (physically, emotionally, or spiritually) to any person in any way.
• Respect the property of others, including all program facilities and property.
• Follow all appropriate instructions of all personnel aiding in this event, including, but not limited to, chaperones, support staff, transportation personnel and administration.
• Be on time for all check-ins and departure time.
• Not have in my possession any tobacco, alcohol or any controlled illegal substance

I agree that if any of these terms are violated, the Parish/School/AFC can send the participant home at the participant/guardian’s expense.

__________________________________________________        ____________________________________

                                ^{Youth Participant Signature                                                                                                                           Date}

__________________________________________________        ____________________________________

                                ^{Parent/Guardian Signature                                                                                                                             Date}

 

Please return to:      ________________________________________________________________________

No later than:          ________________________________________________________________________

 

PARENTAL/GUARDIAN CONSENT FORM AND INDEMNITY AGREEMENT

The Parish/School/AFC sponsoring this activity is responsible for receiving an

authorized form for each participant under the age of 18.

FIELD TRIP PERMISSION FORM

 

Student/Participant Name _____________________________________Date of Birth ____________Sex_____

Parent/Guardian Name ___________________________Parent/Guardian Name___________________________

Home Address __________________________________Home Address____________________________________

 

Home Phone ____________________________________Home Phone ____________________________________

 

Work/Cell Phone ________________________________Work/Cell Phone _________________________________

 

Date of Event/Field Trip_________Type of Field Trip ____________________Student Cost ________

   Destination ____________________________________________________________________________

       Individual(s)/Teacher(s) in Charge ________________________________________________________

       Estimated Time of Departure _______________________ Return_______________________________

       Mode of Transportation To & From Event/Field Trip________________________________________

 

EMERGENCY MEDICAL TREATMENT: In the event of an emergency, I give permission to transport my child to a hospital.  I agree to allow my child to receive emergency medical treatment at my expense at the discretion of the event sponsor.  I wish to be advised prior to any further treatment by a doctor or hospital.  In the event of any emergency, if you are unable to reach me at the above numbers, contact:

 

________________________________________________  ______________________ __________________

^{Name                                                                                                                            Relationship                                           Phone Number}

HEALTH INFORMATION:

 

Medication my child is taking at present_____________________________________________________________

 

For headache or minor pain, my child may be given___________________________________________________

 

Allergies ______________________________________________________________________________________

 

Other Medical Conditions_________________________________________________________________________

 

Insurance Company _________________________ Family Health Plan carrier number ______________________

 

Family Doctor ____________________________________________ Phone Number ________________________

 

 

I, __________________________________, GIVE PERMISSION FOR _____________________________

       ^{Parent or Guardian Name                                                                                                                       Child Name}

TO PARTICIPATE IN THE ABOVE-DESCRIBED EVENT. I warrant that my child is in good health.  In consideration of my child’s participation, I agree to indemnify the parish/school from any claims or law suits brought by myself, my child, or others, that arises out of any behavior by my child at the event/activity described above.  I also agree to pay reasonable attorney’s fees or expenses incurred by the parish/school in defense of such a claim/suit.

 

I agree to drop my child off at the departure location at least 15 minutes prior to departure and to provide transportation home at my expense.

 

I agree that I am responsible for my child’s conduct and actions.  The event sponsor is not responsible for any injury or damage incurred or caused by my child.  I understand that my child is required to comply with the Code of Conduct provided by the parish/school while participating in the event.  I understand that if my child violates the Code of Conduct he/she may be required to be transported home at my expense.

 

Parent/Guardian Signature ___________________________________________ Date ___________________