Dear Parent or Legal Guardian:

Your child is eligible to participate in a parish-sponsored activity requiring transportation to a location away from the parish premises. This activity will take place under the guidance and supervision of employees from St. Alphonsus and St. Stephen parishes. A brief description of the activity follows:

Name of Event: Middle School Service Week

Destination: St. Stephen Parish Center and various work sites around the Grand Rapids area

Designated Supervisor of Activity: Alma-Jean Fossel and Brittany Renne

Date and Time of Departure: Wednesday, July 12 through Friday, July 14

Method of Transportation: Volunteer drivers (adults, Virtus-certified) and Grand Rapids Public Transportation

Cost: $50 includes transportation, food, and lodging

If you would like your child to participate in this event, please complete, sign, and return the bottom half of this form to School/Parish by July 5, 2017


    Agree I hereby consent to participation of my son/daughter in the event that will take place at St Stephen, St Alphonsus, and away from parish grounds from Wednesday 12 July to Friday 14 July 2017. I further consent to the conditions stated above on participation in this event, including the method of transportation.
    In consideration of my child being allowed to participate in this event, I agree to waive and release, and indemnify and hold harmless St. Alphonsus, St. Jude, or St. Stephen Parishes, any and all affiliated organizations, its/their employees, agents, representatives, volunteers and drivers, from any and all claims I or my child may have, excluding claims for intentional misconduct or gross negligence, arising from or relating to my child’s participation in this event.
    I know that great care shall be taken and that my child will be offered plenty of good food and rest. My child has the following health conditions or is in need of the following diet or medications:
    If medical attention is required in the course of the weekend, I hereby give my permission for my son/daughter to be treated.

    Parent's Name:
    Parent's Email: