Jan 4th Lifeline Permission Slip
Saturday Jan 4th is our monthly Lifeline event!!!.
Departure from St. Joe's: 4:15pm
Return to St. Joe's: 10:30pm

We will be taking a bus to this event. Please bring dinner for the car ride and a snack for later. There will be no food for sale or dinner available at the venue.

Questions?? Contact Gizzy at gizzym@saintjosephsparish.org or 651-784-3015 ext 107
Participant Name *
Date of Birth *
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DD
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Gender *
Parent/Guardian Name *
Parent/Guardian Phone Number *
Medications my child is taking at present
Allergies/Dietary Restrictions
Other Medical Conditions
Family Health Plan Carrier Number
Family Doctor
Doctor's Phone Number
Emergency Contact
Emergency Contact's Phone Number
In consideration of my child's participation, I agree to indemnify the parish/school and the Archdiocese of St. Paul/Minneapolis from any claims brought against the parish/school/Archdiocese of St. Paul/Minneapolis by myself, my child or others, which arise out of any behavior by my child at the event/activity described. I also agree to pay reasonable attorney's fees or expenses incurred by the parish/school and Archdiocese in defense of such a claim/lawsuit. In the event of an emergency, I give permission to transport my child to a hospital for medical treatment. I wish to be advised prior to any further treatment by a doctor or hospital. In the event of any emergency, if you are unable to reach me at the above numbers, contact the emergency contact person listed above. *
Required
I also grant permission for photos from the event to be used by St. Joseph of the Lakes for future advertising/promotion of similar events. *
I acknowledge I am the adult participant or the parent of the above-named student participant, and that this serves as my electronic signature. To sign, please type your first and last name below *
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