DIOCESE OF SAGINAW

PARENT PERMISSION FORM FOR CATHOLIC SCHOOLS, PARISH RELIGIOUS EDUCATION AND YOUTH MINISTRY PROGRAMS

Dear parent or legal guardian:

Your son/ daughter is eligible to participate in a school/parish sponsored activity requiring transportation to a location away from the school/parish premises. Parents/guardians are responsible for transportation to and from events for those children in their care unless otherwise stated (i.e. use of a bus provided by the sponsoring agency). A parent can designate another adult, 21 or older, to transport his or her child. This activity will take place under the guidance and supervision of employees/ volunteers from Saint Anne Catholic School/Parish.

Name of Event: Trip to Leaman’s Green Applebarn

Destination: 7475 North River Road, Freeland, MI

Designated Supervisor of Activity: Mrs. Blasy and Miss Amanda

Date and Time of Departure: Wednesday, October 21 at 8:15 a.m.

Method of Transportation: Carpools – with appropriate Booster Seats

Participant Cost: $3.75 per person including Chaperons (Attach to this form)

(If you send a personal check, please make it out to – Mrs. Pat Blasy. Thank you)

If you would like your child to participate in this event, please complete, sign, and return the following statement of consent and release of liability. As parent or legal guardian, you remain fully responsible for the actions and conduct of your child.

STATEMENT OF CONSENT

I hereby consent to participation by my child, ,

in the event described above. I understand that this event will take place away from the school/ parish grounds and that my child will be under the supervision of the designated school/parish employee/ volunteer on the stated dates. 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 field trip, I agree to indemnify and hold harmless and defend Saint Anne Catholic School/ Parish any and all affiliated organizations, their employees, agents, and representatives, including volunteer and other drivers, from any and all claims, including negligence, arising from or relating to my child’s participation in this field trip. This indemnification and hold harmless and defense agreement does not apply to claims for intentional misconduct.

__________________________ ______________________

(Print parent’s name) (Parent’s signature) (Date)

If drivers are needed, are you willing to drive: Yes No

If so, how may _________

Please return this form & money by: October 19, 2009 to Mrs. Blasy

(Date) (Person)

(August 2007)