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Pilgrim Cluster
Catholic Parishes - Alton/Granville/Hospers, IA
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Diocese of Sioux City Field Trip Annual Parental Guardian Consent Form and Liability Waiver
Faith Formation
Faith-Related Links
Religious Education Program
Diocese of Sioux City Field Trip Annual Parental Guardian Consent Form and Liability Waiver
Diocese of Sioux City Field Trip Annual Parental Guardian Consent Form and Liability Waiver
SIoux CIty Diocese Field Trip Annual Parental Guardian Consent Form and Liability Waiver
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PLEASE READ THE DIOCESE OF SIOUX CITY FIELD TRIP ANNUAL PARENTAL GUARDIAN CONSENT FORM AND LIABILITY WAIVER ATTACHED ABOVE. AFTER READING, PLEASE COMPLETE THE FOLLOWING INFORMATION. PLEASE ENTER YOUR NAME THAT YOU HAVE READ IT BELOW.
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Participatn's Name:
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Participant's Date of Birth:
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Parent or Guardian Name(s):
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Home Address:
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I/We (Enter Parental/Guardian Name in Text Box Below), the undersigned parent(s) or guardian(s) each agree to the gollowing. I grant permission for my child (Enter Child's Name in Text Box Below) to participate in parish youth ministry events that require transportation to a location away from the parish site. Activities will take place under the guidance and direction of parish employees and/or volunteers from The Pilgrim Cluster Parishes of St. Anthony - Hospers, St. Joseph - Granville, St. Mary - Alton. I understand that a brief permission slip will be required for each event my child participates in during the calendar year. The brief permission slip will include:
Type of event
Destination of event
Individual in charge
Estimated time of departure to and from event
Special characteristics of, or needs for, the event
A line for the signature of the parent or guardian
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, that for the benefit of The Pilgrim Cluster Parishes, St. Anthony-Hospers, St. Joseph-Granville, and St. Mary-Alton its officers, director, and agents, and the Diocese of SIoux CIty, chaperones, and representatitves associated with the event, (referred to collectively as "them"), that I/We release and forever discharge them from any and all claims and causes of action that we may have against them, arising in connection with the activities of the participant child while attending an event or in connection with any illness or injury or cost of medical treatment therewith.
Parent/Guardian Name(s) and Date
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Student Name and Date
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Field Trip Consent Form
Field Trip Consent Form - I Agree
Field Trip Consent Form
Field Trip Consent Form - I Disagree
MEDICAL MATTERS: I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. (Of the following statements pertainint to medical matters, sign only those that are applicable.)
EMERGENCY MEDICAL TREATMENT: In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor.
Parent(s)/Guardian Name and Date
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MEDICAL MATTERS
MEDICAL MATTERS - I AGREE
EMERGENCY MEDICAL TREATMENT
EMERGENCY MEDICAL TREATMENT - I AGREE
Please be advised that the concurrent medical information is on the Pilgrim Cluster Registration Form. Please complete that informatoni also.
If you have any questions, please contact Tamara List, Director of Religious Education at: Tamara.List.1958@outlook.com or Cell Phone: 712-548-8375
Thank you!
Tamara.List.1958@outlook.com
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