St. Gerald Worlds of Fun Trip
Date: Wednesday, June 19th, 2019

Time: Check in at 6:03am at St. Gerald Lakeview Campus. Return around 9:00pm

Transportation: Charter Bus

Cost: $89 Covers transportation, lunch, and park entrance fee. Bring extra cash for dinner, games and souvenirs.
We will stop for fast food on our way home.

Registration Deadline: May 19th, 2019 Completing this form online and submitting payment to the Business Office, will secure a spot on the trip.

Make Checks payable to St. Gerald
Contact Deb True or Kelly O'Donnell for more information, 402-331-1955 or dltrue@stgerald.org or kodonnell@stgerald.org

Participant Information
Participant Name (First & Last) *
Your answer
Gender *
Grade (at beginning of 2019/2020 school year) *
Birthdate *
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DD
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YYYY
Parent/Guardian Name (Self for Leaders) *
Your answer
Participant Cell Phone Number *
Your answer
Home Address *
Your answer
City/State/Zip *
Your answer
Parents email *
Your answer
Parent's phone *
Your answer
Parent/Guardian Consent Form/Liability Waiver
I, (Parent/Guardian Name) grant permission for my child, (Participant Name) to participate in this parish youth ministry event that requires transportation to a location away form the parish site. This activity will take place under the guidance and direction of the parish employees and/or volunteers from St. Gerald Parish. *(Parent/Guardian Name, Paricipant Name) *
Your answer
As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above name minor (participant). I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harm-less and defend St. Gerald, its officers, directors and agents, and the Archdiocese of Omaha, chaperones, or representatives associated with the event, arising from or in connection with my child attending the event or in connection with any illness or injury or cost of any medical treatment in connection therewith, and I agree to compensate the parish, its officers, directors and agents and the Archdiocese, chaperones or representative associated with the event for reasonable attorney's fees and expenses arising in connection therewith. (Filling the field with Parent/Guardian Name) *
Parent/Guardian Name, Relationship (Signature) *
Your answer
Medical Release
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. *
Parent/Guardian Name, Relationship (Signature) *
Your answer
Emergency Medical Treatment
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. In the event of an emergency, if your are unable to reach me at the above numbers, please contact: (Emergency Contact Name, Emergency Contact Phone Number) *
Your answer
Family Doctor *
Your answer
Family Doctor Phone Number *
Your answer
Family Health Plan Carrier *
Your answer
Family Health Plan Policy Number *
Your answer
Allergies *
Your answer
Are there any existing medical conditions or medications an emergency physician would need to know (allergies, drug reactions etc.)? List if YES, N/A if NO *
Your answer
Additional Information
Photos may be taken of participants at this event for use in Parish related publications (website, newsletter, Spirit Link etc.) Names will be withheld. *
As a Parent/Guardian, are you available to help chaperone this event? *
(For Youth) I understand that Christian behavior is expected at all times. Respect for individuals, the community and the facilities is required. Dress is casual but appropriate for a Christian environment. T-Shirts/sweatshirts with alcohol, tobacco or sexual overtones are not acceptable, nor is clothing exposing any part of under garments. If I wear inappropriate clothing, I understand that I will not go on the trip. I also understand that I am responsible for cleaning up after myself everywhere, especially on the bus.
Youth Name (Signature) *
Your answer
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