St. Peter Damian Parental Consent Form Feed My Starving Children printable pdf download

St. Peter Damian Parental Consent Form Feed My Starving Children

St. Peter Damian

Parental Consent Form

Feed My Starving Children

I, __________________________, the legal parent(s)/guardian(s) of _____________________,

grant permission for my child to participate in Feed My Starving Children sponsored by the Confirmation Program

of St. Peter Damian. I understand that this activity will take place in Schaumburg at the Feed My Starving Children

facility. I understand that my child will be transported to and from the facility by volunteer adult drivers.

I/We hereby release and indemnify the Catholic Bishop of Chicago, a corporation sole, the Religious Education

Office, the Parish and the staff and volunteer from any and all liability arising from claims of any kind or nature

whatsoever from my child’s participation in this event.

I understand that if my child violates any laws regarding possession of alcohol or drugs, or rules governing the

event, I will be called to pick my child from the premises.

In the event that the undersigned cannot be reached and in the judgment of the responsible adult of this program or

other staff member, there is a necessity for immediate examination and /or treatment of my child, I HEREBY

AUTHORIZE any of the aforesaid personnel to obtain for my child, such medical services as are deemed

necessary.

List emergency contact:

Name________________________ Phone #____________ Relationship to Child__________________________

Please list any allergies, medications, medical problems and physical activities that your teen cannot take part in and

any other important medical information.

_____________________________________________________________________________________________

***With my signature I confirm that the information given on this form is correct.

___________________________________________

_______________________________________

Signature of Parent/Guardian

Date

St. Peter Damian Parental Consent Form Feed My Starving Children