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Dec. 10th COR Night Form - Deadline Dec. 5th

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  Field Trip Parental Consent Form & INDEMNITY AGREEMENT
  
  Parent/Guardian Info.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Student/participant info.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender and D.O.B. REQUIRED Please fill out this field. Please enter valid data.
  
  Parish/School: Holy Cross AFC
  Date of Event: Dec. 10th, 2023 Type of Field Trip: DNU COR Night
  Destination: St. Aloysius | Olivia, MN
  Individual(s) in charge: Gabrielle Osborne
  Estimated time of Departure: 3:00pm (arrive at 2:45pm) Return: 9pm
  Mode of Transportation to & from Event: Chaperone Carpool
  Student and Chaperone Cost: $20
  **pizza dinner provided**
  **Drop-off & pick-up in Cathedral parking lot**
  
  I grant permission for my child(ren) to participate in the above-named activity and I warrant that my child is in good health. In consideration of my child's participation, I agree to indemnify the Holy Cross AFC / Diocese of New Ulm 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 Holy Cross AFC and the Diocese of New Ulm in defense of such a claim/suit.
  
  I Agree Please select this field.
  
  EMERGENCY MEDICAL TREATMENT: In the event of an emergency, I give permission to transport my child to a hospital for medical treatment. 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:
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  OPTIONAL MEDICAL INFORMATION:
  
  Medication my child is taking at present: Maximum 20 characters Please enter a phone number.
  
  Allergies: Maximum 20 characters Please enter a phone number.
  
  Other medical conditions: Maximum 20 characters Please enter a phone number.
  
  Family health plan carrier number: Maximum 20 characters Please enter a phone number.
  
  Family Doctor & their phone number: Maximum 20 characters Please enter a phone number.
  
  As a parent/guardian, I agree to all the above stated considerations and conditions.
  
  Parent Signature REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Date REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Submit
  
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