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:

1. Type of event
2. Destination of event
3. Individual in charge
4. Estimated time of departure to and from event
5. Special characteristics of, or needs for, the event
6. 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.

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.

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!