Youth Group Sky Zone 2019
Middle Schoolers and High Schoolers,
Bring your friends and join us for a trip to:
Sky Zone

Sunday, April 28, 2019
From 2:00-4:00pm
At Good Shepherd

We will meet at Good Shepherd at 2:00 and then drive to Sky Zone. We will have open jump time from 2:30-3:30pm and then drive back to Good Shepherd by 4:00pm. We will need parents to chaperone and drive.

Cost is $15 per jumper. Please make checks payable to Good Shepherd.

All participants must fill out the waiver at www.skyzone.com/Milwaukee prior to the event.

Email address *
Participant Information
Participant 1 First Name *
Your answer
Participant 1 Last Name *
Your answer
Participant 1 Gender *
Participant 2 First Name
Your answer
Participant 2 Last Name
Your answer
Participant 2 Gender
Participant 3 First Name
Your answer
Participant 3 Last Name
Your answer
Participant 3 Gender
Parish or Friend Of *
Parent Information
Parent/ Guardian First Name *
Your answer
Parent/ Guardian Last Name *
Your answer
Alternate Email
Your answer
Contact Information During Event
NAME OF CONTACT PERSON *
Your answer
BEST PHONE FOR CONTACT PERSON *
Your answer
ALTERNATIVE CONTACT NAME (If unable to reach person above) *
Your answer
ALTERNATIVE CONTACT BEST PHONE *
Your answer
Medical Information
PHYSICIAN'S FULL NAME *
Your answer
PHYSICIAN'S PHONE *
Your answer
NAME OF MEDICAL INSURANCE *
Your answer
MEDICAL INSURANCE POLICY NUMBER *
Your answer
PERTINENT MEDICAL CONDITIONS
Your answer
INHALER/EPI-PEN
Allergy Information
ANY FOOD ALLERGIES TO BE AWARE OF?
Your answer
Would you like to help out?
Would you like to chaperone? We need adults willing to chaperone and drive to Sky Zone from Good Shepherd. Please indicate the number of youth you can fit in your vehicle in "Other"
Digital Signature
Indemnity Agreement:
**In consideration for my child/ward participation, I agree to reimburse and indemnify parishes for all reasonable legal and court fees incurred by parishes in defending a lawsuit that I or my child/ward may bring against parishes, which relates to the above named activity if is found not legally liable by the courts and prevails in the lawsuit. If the parishes are found legally liable for injuries sustained by son/daughter/ward, this paragraph will not apply. I certify that I have an understanding of this agreement and any risks and hazards associated with the activity described above that my child/ward will be participating in. I further understand that I have the opportunity to fully discuss this agreement with a representative of the parishes to clarify any concerns or questions about the activity or this agreement that I may have. As parent or guardian of the above named student, I give permission for my child to participate in the field trip described above.
**Photo & Video Release: I hereby give my permission to the parishes for photographs and/or videos that may include my child’s image to be used in promotional materials. This includes any prints, slides, copies, reductions, or any other processes or treatments necessary to make a photograph/video for reproduction purposes. I release all rights and privileges for financial obligations for this permission.
**In the event of an emergency, I give permission to transport my child to a hospital for emergency medical treatment. I wish to be advised prior to any further treatment by the hospital or doctor.
By entering my full name, I attest that this constitutes my legal electronic signature on this form. *
Your answer
A copy of your responses will be emailed to the address you provided.
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