St. Dominic CYO Spring Retreat

St. Dominic CYO Spring Retreat Permission Form

Parental/Guardian Consent Form and Liability Waiver
Participant's Name

First NameLast Name
Birth Date
Sex

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Member of St. Dominic CYOMember of St. Pius CYOConfirmation Candidate at St. Dominic
Parent/Guardian's Name
Address

Street Address

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Participant's Cell
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Mother's Cell
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Father's Cell
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I, Parent/Guardian First Name Last Name , grant permission for my child, Participant's First Name Last Name , to participate in this parish activity that may require transportation to a location away from the parish site. This activity will take place under the guidance and direction of parish employees and/or volunteers from St. Dominic Parish. A brief description of the activity follows:
- Type of event: Spring Retreat
- Location(s): Lumen Christi Retreat Center (100 Lumen Christi Court Schriever, LA. 70395)
- Individual(s) in charge: Courtney Jansen
- Duration of activity: Friday, March 27 at 5 PM - Saturday, March 28 at 5 PM
- Mode of transportation to and from event: School Bus
As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor (“participant”).

I confirm that there are no necessary changes to the Medical Information Consent form for my child that I previously submitted. If there are any necessary changes, I will complete another Medical Information Consent form.

I agree on behalf of myself, my child named herein, and my spouse, our heirs, successors, and assigns, to indemnify, hold harmless, and defend St. Dominic Catholic Church, St. Pius X Catholic Church and The Roman Catholic Church of the Archdiocese of New Orleans, their members, directors, officers, employees, agents and representatives associated with the event arising from or in connection with the negligence and/or intentional acts of my child.
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Spring Retreat Fee

Scholarships available. Contact Courtney (St. Dominic) or Ben (St. Pius) to discuss.

$88.00 Quantity

Confirmation Retreat Participant

Included with Confirmation Registration Fee

$ Free Quantity

Total

$0.00

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St. Dominic CYO Spring Retreat Permission Form

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