St Leo/Vincent's Youth Event
Parental/Guardian Consent Form & Medical Information--2009/2010
Parents/Guardian Name ___________________________________________
Address ________________________________________________________
Home phone ______________________ Cell phone ____________________
I, ____________________________ grant permission for my child(ren):
Child(ren)'s Name ___________________________ Grade __________
Name ___________________________ Grade __________
Name ___________________________ Grade __________
Name ___________________________ Grade __________
To participate in parish youth activities that are away from St. Leo's Parish.
I understand that these activities will take place under the guidance and
direction of a parish employee and/or volunteer from St. Leo/Vincent's parish
who shall exercise due care and caution in providing for the safety of his/her
young person while on such excursions. Parent will be notified before the
activity/event takes place.
As a parent and or legal guardian, I remain legally responsible for any
personal actions taken by the above minor name and grant to Fr. Thury or
another supervisory adult along to authorize emergency medical treatment if
that treatment is deemed immediately necessary by competent medical authority.
Medical Information:
Please lest any medical conditions, special medications, or allergies etc., of your
child that we need to be aware of in case of a medical emergency:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Parent/Guardian Signature ___________________________ Date ________