Youth Ministry Permission Form

Type of event: Summer Stretch
Date of event: June 13th-17th, 2022
Destination of event: varies each day, meet each day at DMCS
Student cost: $165 for middle schoolers, $70 for high school leaders
Individual in charge: Andrea Gibbs
Estimated time of departure: 8am
Estimated time of return: 4:30pm
Mode of transportation: School Bus
 
Type of event: Totus Tuus Day Program Grades 1-6
Date of event: June 27-July 1, 2022 9am-2:30pm
Destination of event: Divine Mercy Catholic School
Student cost: $50
Individual in charge: Anna Blessing
Estimated time of departure: n/a
Estimated time of return: n/a
Mode of transportation: n/a
 
Type of event: Totus Tuus Evening Program Grade 7-12
Date of event: June 26-30, 2022 7-9pm
Destination of event: Divine Mercy Catholic Church/Farmhouse
Student cost: FREE
Individual in charge: Anna Blessing
Estimated time of departure: n/a
Estimated time of return: n/a
Mode of transportation: n/a
 
Type of event: Nun Run High School Girls 
Date of event: June 5-10, 2022 
Destination of event: Route TBD
Student cost: $300 (does not include meals that are on the road)
Individual in charge: Anna Blessing
Estimated time of departure: TBD
Estimated time of return: TBD
Mode of transportation: TBD
 
Type of event: Youth Group Saints Game
Date of event: Tuesday, August 9th
Destination of event: Cosettas & CHS Field
Student cost: $20 (Does not include money for dinner)
FYI: CHS field is "cashless". You either need to have a card or exchange money at the park for Saint Bucks at the gift shop. This is why we are going to Cosettas for dinner before hand so kids can eat and pay in cash. 
Individual in charge: Anna Blessing
Estimated time of departure: 4pm
Estimated time of return: 10pm
Mode of transportation: Faribault Transportation
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I, (parent/guardian listed above) grant permission for my child, (student listed above), to participate in this parish/school event that requires transportation to a location away from the parish/school site. This activity will take place under the guidance and direction of parish/school employees and/or volunteers from Divine Mercy Catholic Church.

I understand and agree that as parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor (“student/participant”). Further, I hereby warrant that to the best of my knowledge, my child is in good health and I assume all responsibility for the health of my child.

I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend Divine Mercy Catholic Church, its officers, directors, employees and agents, and the Archdiocese of Saint Paul and Minneapolis, its employees and agents, chaperones, or representatives associated with the event and activities (hereinafter “Releasees”), from any claim, including but not limited to all claims relating to communicable disease, arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate Releasees for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of Releasees.

USE OF IMAGE: I grant permission to Divine Mercy Catholic Church and the Archdiocese of St. Paul & Minneapolis to use and publish for advertising,  commercial or publicity purposes, likeness of my child, or for any other lawful purposes whatsoever, including photographic portraits, pictures, reproductions, made through any medium, including electronic media, and the undersigned parent/guardian does hereby release Divine Mercy Catholic Church and the Archdiocese of St. Paul & Minneapolis or anyone authorized by the with such use. This authorization and consent permits such use to associate my child’s name with the likeness for such purposes provided such use is consistent with the acceptable use policy for electronic communications and other policies.

Signature: *
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Medical Information

Emergency Medical Treatment: In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. In the event of an emergency, if you are unable to reach me at the above numbers, contact:

Specific Medical Information: The parish/school will take reasonable care to see that the following information will be held in confidence.
As a Parent or Guardian, I agree to all of the above stated considerations and conditions.
Signature: *
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Current Total:
$0.00
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