Youth Ministry Event Participation Permission and Release for Service Project at Chapman Place
For high school students only. We will be doing a service project for Chapman Place (3110 E Coliseum Blvd, Fort Wayne, IN 46805) on Tuesdays in July from 10am-noon. On Tuesday, July 10th, we will meet at St. Charles Youth Center for service training from 10am-noon. On Tuesday, July 17, 24, and 31, we will be meeting at Chapman Place for our actual service event. We plan to build a garden with the elderly residents at the nursing home. Transportation is not provided by St. Charles.
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Email *
*A new Event Participation form must be completed for each Event. Information provided in the Annual Emergency Medical Care Form will apply to each Event in which your child is allowed to participate during the Youth Ministry Program year. Parents/guardians are responsible for updating the information on that form should changes occur during the Youth Ministry Program year.
Parent/Guardian Name *
Address: *
Telephone: *
Student/Participant Name: *
Participant Age: *
Participant Grade *
I allow my child to participate in the parish event Service at Chapman Place on July 10, 17, 24, and 31 (July 10th training at St. Charles). In consideration of the aforementioned participant, my child, being allowed to participate in this event, I, on behalf of myself, my child and my child’s other parent/guardian, hereby acknowledge recognition that such an activity may expose my child to risks and hazard not ordinarily encountered in the parish youth ministry program. Further, on behalf of myself, my child, and my child’s other parent/guardian, I hereby release and agree to hold harmless the above named parish and the Diocese of Fort Wayne-South Bend, Inc. to the fullest extent permitted by law from any and all claims, judgments and liability of every kind for any injury and damage of any kind, whether personal or property, that we or any one of us may suffer or incur due to my child’s participation in the event, regardless of whether the injury or damage is attributable to the fault of parties other than the Parish or Diocese or attributable to the fault, including negligence, of the Parish or Diocese. I have instructed my child to follow the rules of conduct as directed by the parish youth ministry program and Diocese. *
As the parent/legal guardian of the above named student, I attest that this form is complete complete to the best of my knowledge. In order for this form to be verified, it must also be confirmed by calling the St. Charles Youth Ministry Office to verify consent. Once you submit this form, parents/guardians will be sent an e-mail with instructions to call (260)484-7307 to verify your online consent.
Parent, please type your name if you agree *
A copy of your responses will be emailed to the address you provided.
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