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Parent/Guardian Consent Form and Liability Waiver (for student)

- Faith Formation
  - Religious Education Program
    
    New Enrollment
    Re-Enrollment
    Medical Consent Form and Liability Waiver
    Student Field Trip Waiver Form
    
    Adult Field Trip Waiver Form
    Summer VBS 2022
  - Faith-Related Links

IMPORTANT NOTE:

This form does not need to be filled out at the beginning of the year. It will be completed by families as needed when students are involved in activities or field trips.
For each event/field trip, you may fill out this online form or you may click on the link to fill out paper form and submit to Diane Rainbolt, Director of Faith Formation.
Link to paper Consent Form (below)
- SIoux CIty Diocese Field Trip Parental Guardian Consent Form and Liability Waiver
The maximum number of form submissions has been reached. This form is currently not available.
- Participant Information
  
  Participant's Name: REQUIRED Please fill out this field. Please enter valid data.
  
  Participant's Date of Birth: REQUIRED Please fill out this field. Please enter valid data.
  
  Parent or Guardian Name(s): REQUIRED Please fill out this field. Please enter valid data.
  
  Home Address: REQUIRED Please fill out this field. Please enter valid data.
  
  Home Phone: REQUIRED Please fill out this field. Please enter valid data.
  
  Cell Phone: REQUIRED Please fill out this field. Please enter valid data.
- Event/Field Trip Information
  
  Date of Event REQUIRED Please fill out this field. Please enter a date.
  
  Type of Event REQUIRED Please fill out this field. Please enter valid data.
  
  Destination of Event REQUIRED Please fill out this field. Please enter valid data.
  
  Individual in charge REQUIRED Please fill out this field. Please enter valid data.
  
  Estimated time of departure REQUIRED Please fill out this field. Please enter valid data.
  
  Estimated time of return REQUIRED Please fill out this field. Please enter valid data.
  
  Mode of transportation REQUIRED Please fill out this field. Please enter valid data.
- I/We, the undersigned parent(s) or guardian(s) each agree to the following.
  
  I grant permission for my child named herein to participate in this parish sponsored event that requires transportation to a location away from the parish sites. This activity will take place under the guidance and direction of parish/school employees and/or volunteers from The Pilgrim Cluster Parishes of St. Anthony - Hospers, St. Joseph - Granville, St. Mary - Alton, Iowa.
  
  As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above-named minor ("participant").
  
  I agree on behalf of myself, my child named herein, my spouse, and our heirs, successors, and assigns, to hold harmless and defend Pilgrim Cluster parishes: St. Mary's - Alton, St. Anthony's - Hospers, St. Joseph's - Granville, its officers, directors, employees and agents, and The Diocese of Sioux City, its employees, and agents and chaperones, or representative associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from negligence of the parish/school/diocese.
- I agree to the above consent statement and liability waiver.
  I Agree Please select this field.
- Student Signature REQUIRED Please fill out this field. Please enter valid data.
- Parent Signature REQUIRED Please fill out this field. Please enter valid data.
- Today's Date REQUIRED Please fill out this field. Please enter a date.
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Parent/Guardian Consent Form and Liability Waiver (for student)

This form does not need to be filled out at the beginning of the year. It will be completed by families as needed when students are involved in activities or field trips.

For each event/field trip, you may fill out this online form or you may click on the link to fill out paper form and submit to Diane Rainbolt, Director of Faith Formation.