Magic Springs 2021 Permission Slip
Day at Magic Springs and Tauren Wells concert, July 31st, leaving Family Activity Center parking lot and returning around 10ish. Cost to participate: $15 (scholarships available) LIMITED TICKETS AVAILABLE!
Student Name *
Student Age *
Grade *
Parent Name *
Parent contact information *
The following are a few rules all participants are expected to follow while participating in this event: *
I (guardian) grant permission for my child (participant) to participate in the above listed event. I agree on behalf of myself, my child's other parent if known or living (parent), my child named herein or our heirs, successors, and assigns, to hold harmless and defend the Diocese of Little Rock, St. Joseph Catholic Church (its pastor, youth minister, other agents, etc.) or any representatives associated with the scheduled activity unless the parties involved were careless or negligent. *
I give my son/daughter permission to be a passenger in a protocol-ed adult chaperone's car or ride a bus (as arranged by the St. Joseph Youth Ministry) for the purpose of going to and from the event listed above. I understand all passengers in a private vehicle must wear seat belts, by my agreeing, I agree to hold harmless of neglect any adult chaperone, any staff member, the school, parish or diocese, in case of an accident occurs while on this trip. *
I give permission for my son/daughter to be photographed and to publish the photo in local, diocesan and parish media, both printed and electronic. I also give the youth ministry department permission to contact my son/daughter through phone or electronic media regarding this event. *
I hereby warrant to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.
Of the following statements pertaining to medical matters, sign only accordance to your wishes: in the event of any 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. In the event of any emergency and you are unable to reach me, contact (name and phone #): *
Medications? *
I grant permission for medication or any type, whether prescription or nonprescription may be administered by my child unless the situation is life threatening and emergency treatment is required. *
Medical conditions and information: *
Immunizations current and up to date? *
Insurance information (don't complete if you've already done so for past events and nothing has changed) Insurance carrier, Name of insured, insurance ID #, Fathers name, DOB and place of employment, Mothers name, DOB and place of employment. OR state that you do not carry medical insurance at this time. *
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