Washington on the Brazos - 4th Grade
Your child is eligible to participate in a school-sponsored activity requiring transportation to a location away from the school building and grounds. This activity will take place under the guidance and supervision of employees from St. Mary’s Catholic School. A brief description of the activity follows:

Name of Event: Washington on the Brazos
Designated Supervisor of Activity: Mrs. Quintana
Date: April 4, 2017
Time of Departure: 7:45 am
Time of Return: 4:30 pm
Method of Transportation: Parent Drivers
Student Requirements: Bring a sack lunch & regular uniform

By submitting this form you agree to this event. You give consent and release of liability. As Parent/Guardian you remain fully responsible for any legal responsibility which may result from any personal actions taken by the named student.

In consideration for the making of the arrangements for this trip, I/We hereby release and save harmless the St. Mary’s Catholic School, all its employees and the Diocese of Austin from any and all liability arising to my child as a result of this trip. I also agree to allow my child to travel on this trip in a private vehicle.

If emergency treatment is required for my child, I/We authorize St. Mary’s Catholic School personnel to follow area EMS regulations in caring for my child.

Email address *
I/We, the Parent(s)/Guardian(s) of _____________ request that St. Mary’s Catholic School allow my child to go to Food For Families *
Your answer
Parent/Guardian’s Electrionic Signature *
Your answer
Emergency Contact Phone *
Your answer
Cost per student $3. Cost per chaperone $9 *
If you can chaperone and are EIM compliant, please fill out the information below.
I would like to drive and am EIM compliant.
The office has a copy of my car insurance and driver's license.
My car holds _____ plus the driver.
Your answer
Name of the driver
Your answer
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