Catholic Central Middle School Dance Permission Slip

Catholic Central Middle School Dance Permission Slip

Students in grades 6-8 are invited to an unforgettable night of fun, music, and glow in-the-dark excitement at Catholic Central High School’s Topper Hall in Burlington, WI! This isn’t just any dance—prepare for a night filled with awesome beats from a live DJ, exciting giveaways, and plenty of surprises! Pizza and snacks will be available to purchase so you can keep dancing all night long.
Student Full Name*

First NameLast Name
Student Grade*
Name of Current School *
Parent/Guardian Full Name*

First NameLast Name
Parent/Guardian Phone Number*
Please enter a valid phone number.
Parent/Guardian Email Address*
example@example.com
Song Request/List Your Favorite Dance Song
As parent or guardian of the above named student, I give permission for my child to participate in the field trip described as follows:

Event: Middle School Dance - Glow Bash

Date: Friday, April 10, 2026

Event Location: Catholic Central High School - Marian Activity Center -148 McHenry St., Burlington, WI 53105

Hosted by: Catholic Central Parent Connectors

Phone: (262) 763-1506

Time: 7:00 pm - 9:00 pm

Cost: $5 (Payable on this form)
Medical Information and Release*

I agree
In the event of an emergency, I give permission to transport my child to a hospital for emergency medical treatment. I wish to be advised prior to any further treatment by the hospital or doctor.

On field trips that occur during the length of the school day, any prescription medication already provided to the school will be carried and administered by staff.

If you are unable to reach a parent/guardian at the above number, contact:
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Does your child have any allergies or medical conditions we should be aware of? If yes, please specify.
Field Trip Consent and Release:*

I agree
In consideration for my child/ward’s participation, I agree to reimburse and indemnify the parish/school for all reasonable legal and court fees incurred by parish/school in defending a lawsuit that I or my child/ward may bring against the parish/school Which relates to the above named activity if the parish/school is found not legally liable by the courts and prevails in the lawsuit. If the parish/school is found legally liable for injuries sustained by child/ward, this paragraph will not apply.

I certify that I have an understanding of this agreement and any risks and hazards associated with the activity described above that my child/ward will be participating in. I further understand that I had the opportunity to fully discuss this agreement with a representative of the parish/school to clarify any concerns or questions about the activity or this agreement that I may have had.
By entering my Signature & full name, I attest that this constitutes my legal electronic signature on this form. Please NOTE: Signature is required to complete form
Parent/Guardian Signature*

Powered by Jotform SignClear
Parent Guardian Signature (Print Name Required)*

First NameLast Name
Date*

MonthDayYear
Date
If you wish to opt out of any image, photograph, or video of your child to beposted or published to social media by any chaperone or school personnel forthis field trip, check here*

YesNo
My Products
prevnext( X )
Dance Entry Fee
$5.00 Quantity

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Catholic Central Middle School Dance Permission Slip

By entering my Signature & full name, I attest that this constitutes my legal electronic signature on this form. Please NOTE: Signature is required to complete form