SCHS Parent / Guardian Permission for Community Involvement Day - October 2, 2019
On Wednesday, October 2, 2019, Skutt Catholic students and faculty will again participate in Community Involvement Day. As a wonderful tradition, students go out into the community to learn about people and agencies that are serving others, and then provide service themselves. The students will go with their homeroom and faculty/staff member or parent volunteer to schools, nursing homes, and many other locations, transported by parents, faculty members, or other adults.

Please complete the consent form and liability waiver below BY FRIDAY, SEPTEMBER 13th. You will need to complete one form for each student. Thank you!
Email address *
Student's First Name *
Your answer
Student's Last Name *
Your answer
Student's Grade *
Student's Homeroom Teacher *
Parent / Guardian’s Name *
Your answer
Parent / Guardian's Phone Number *
Your answer
Parent / Guardian's Secondary Phone Number (optional)
Your answer
Volunteer Drivers Needed
PARENTS: If you are willing and available to help drive either one way or both ways, please check below or contact your homeroom teacher. The times are approximately 8:45 a.m. leaving from Skutt Catholic to sites, and pick-up at 1:15 p.m. from the site back to Skutt. You are also welcome to stay with the homeroom and serve at the site. Thank you for your help and prayers for a successful and rewarding day.

PLEASE NOTE: All volunteers need to provide a copy of their driver's license and proof of insurance to their student's homeroom teacher prior to transporting Skutt Catholic students. Additionally, our insurance provider, Catholic Mutual, requires that all volunteer drivers complete a short online module. The directions for completing this will be given to you.

(If you have completed the online module in the past, you do not need to complete it again, but you will still need to provide a current copy of license and insurance.)
YES, I want to help make CID very successful! I am able to help drive: (Your student’s homeroom teacher will contact you with the details.)
# of seatbelts for students in my vehicle
Your answer
Email Address
Your answer
Have you previously completed the Online Volunteer Driver Module from Catholic Mutual?
Our insurance provider, Catholic Mutual, requires that all volunteer drivers complete a short online module. The directions for completing this will be given to you. (If you have completed the online module in the past, you do not need to complete it again, but you will still need to provide a current copy of license and insurance.)
If my student’s homeroom has enough drivers, I would be willing to drive for another homeroom.
Consent, Liability, and Medical Matters
I hereby consent to participation by my child in this school-sponsored event that requires transportation to a location away from the school site. This activity will take place under the guidance and direction of school employees and/or volunteers from Skutt Catholic High School.

A brief description of the activity follows:
Activity: Community Involvement Day
Destination of Event: Various local service sites
Date and Departure Time: Wednesday, October 2, 2019, 8:45 a.m. approximately
Anticipated Return Time to Skutt Catholic: 1:40 p.m. (approximately) [12:00 p.m. for some sites]
Method of Transportation: Vehicles of parents, faculty members, other adults

As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor (“participant”). I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend Skutt Catholic High School, its officers, directors and agents, and the Archdiocese of Omaha, chaperones, or representatives associated with the event, from any illness, injury, or cost of medical treatment, arising from or in connection with my child attending the event described above, that is not the result of intentional neglect or willful or wanton misconduct by the school, its agents, representatives or employees.

Medical Matters: 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. In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor.
If you agree to the consent, liability, and medical information above, please check the agree box below and enter your name and date in the fields below. *
Full Parent Legal Name *
Your answer
Date *
MM
/
DD
/
YYYY
Please note any special medical concerns that the homeroom teacher will need to know for CID.
Your answer
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