Altar Server Hershey Park Trip, 19 JULY 2017
Wednesday, 19 JULY 2017
Depart: 7:00AM (after the 6:15AM Mass)
Return: Late (10:00PM)
Cost: $10 Reservation Fee (non-refundable, will be returned to the server in a park coupon for food, etc)
Fill out the form for each server attending. The form will redirect to the payment page (you can total the number of servers and pay once, just list names in the text box on the payment page).
I, the parent/legal guardian of the youth I have designated above, give permission for my child to attend a day-trip to Hershey Park Amusement Park in Pennsylvania on 19 JULY 2017 with an anticipated departure time of 7:00AM and return time of 10:00PM. I understand and acknowledge that participation in the activities involves inherent risks of injury to my child including risks associated with transportation by motor vehicle. I do herby agree to release, indemnify and hold harmless chaperones, St. Theresa Parish, Youth Ministers, Volunteers, and the Catholic Diocese of Arlington for any costs or expenses arising out of my child’s participation in the activities including the cost of any medical care given my child or any expenses or fees incurred in any lawsuit arising as a result of any damage or injuries caused by my child in the course of his or her participation in the activities. I further give my consent that in my absence the above-named minor may be admitted to any hospital or medical facility for diagnosis and treatment. I request and authorize physicians, dentists, and staff, duly licensed as Doctors of Medicine or Doctors of Dentistry or other such licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of the above minor. I have not been given a guarantee as to the results of examination or treatment. Photo/Video: Also, I authorize St. Theresa’s Youth Ministry and the Catholic Diocese of Arlington to use my child’s picture or video recording for educational purposes and/or marketing purposes. Parents/guardians who do not wish their child to be photographed or filmed should notify the Religious Education Office in writing. I freely execute this Acknowledgement with full knowledge of its content. I understand that in the event my child becomes ill with a communicable illness during the trip, I have to make immediate arrangements to retrieve my child from the trip location.