Office of Development and Properties at 601 S. Jefferson, Springfield, MO 65806 US - Field Trip Permission Form - (Overnight or Multi-Day)
| Field Trip Permission Form - (Overnight or Multi-Day) |
Note: this form may need to be signed twice by parents; once to request participation and again (notarized) if they wish to authorize emergency medical treatment. I/We, the parent(s)/guardian(s) of , request that Immaculate Conception parish allow my/our son/daughter to participate in the following youth group activity on Friday and Saturday, September 27 and 28, 1996: Overnight camping trip to Sam A. Baker State Park Participants should meet at 6:00 p.m. at the church parking lot. Departure at 6:30. Special conditions: Swimming gear should be brought since swimming in the stream will be allowed. Chaperones will accompany the leaders, John and Joan Youth leader. The educational purpose of this activity is to create an atmosphere of fellowship in the group. I/We understand Immaculate Conception parish will provide transportation. My/our son/daughter has permission to ride with a volunteer driver. I/We understand that no one under the age of 21 will be allowed to serve as a driver. I/We hereby release and hold Immaculate Conception parish harmless as well as any and all of its employees and volunteers from any and all liability for any and all harm arising to my/our son/daughter as a result of this trip. Date: Signed: Emergency Phone #: Signed: Emergency Phone #: I/We further authorize emergency medical treatment for my/our son/daughter should the need arise while on this trip. (List any medication or special medical condition that medical personnel may need to know in case of an emergency.) Signatures for this sections must be signed before a Notary Public. Medication: Medical condition(s): Date: Signed: Signed: ********************************** Subscribed and sworn to me this Day of 20 Signature My commission expires Notary Public