2019 Life Teen Summer Release Form
By completing this form, you are giving permission for your teen to participate in the listed events below. Each child needs their own form completed.
St. Ann Life Teen Summer Program
Type of Event: Summer Kickoff (June 2), Life Night Social at Azalea Park (June 9), Top Golf (June 23), Bowling & Laser Tag (June 30), Atlanta United (July 7), Life Teen Movie Night (July 21), & Life Night Summer Series (July 28 and August 4)

Destination of Events: St. Ann's (Nolan Hall, Reilly Field, Teen Center, La Salette Hall), Azalea Park - Chattahoochee River, Top Golf (10900 Westside Pkwy, Alpharetta, GA 30009), Stars and Strikes (8767 Roswell Rd, Sandy Springs, GA 30350), Mercedes Benz Stadium, & Menchies (The Avenue)

Individuals in Charge: Kelly Simpson & Ryan Cottrill

Estimated time of Departure and Return: *check the Life Teen website for additional info and times

Mode of transportation to and from event: Core members will drive if event is offsite

Cost: please check the St. Ann's Life Teen website for information regarding cost for each event

Name of Student *
Your answer
Sex *
Age *
Your answer
High School Graduation Year *
Parent Name *
Your answer
Phone *
Your answer
Email *
Your answer
I/We the parent(s) of the child named above, do hereby give my/our approval for him/her to participate with the (Life Teen Summer events) that is sponsored by (St. Ann). I/We do hereby, for myself, my heirs, executors, and administrators, waive, release, absolve, indemnify and agree to hold harmless any and all adults who chaperone, also the Archdiocese and its representatives, successors, supervisors, sponsors, organizers and participants for any injuries in connection with the program named above. I likewise release from my responsibility any person transporting my child to and from any of the activities. I/We hereby grant permission for publication of photos taken at youth events. I/We also give permission to seek any emergency care should my child be involved in any accident or be injured in any way during such events named above. I/We understand that in any such instance, all attempts will be made to contact the parent/guardian. In the event that I/we cannot be contacted, I/we hereby give permission to the attending physician to hospitalize, secure treatment for, and to order injection, anesthesia, and/or surgery for my child, as named herein.I also agree that I am legally responsible for all/any personal actions taken by my child/guardianship during this event, and agree to be financially responsible for any/all damages, legal fees, and other costs incurred as a result of the actions/behavior of my child/guardianship. Furthermore, I/we agree that if the above named student’s behavior is inappropriate, unsafe and/or detrimental to the group, I will be contacted immediately to secure means of removing my child/guardianship from the event premises. I understand that any financial costs incurred as a result of my child/guardianship being sent home are my responsibility. *
Required
I grant permission for non-prescription medications to be given, if deemed appropriate by adult chaperone(s). *
I give permission for my teen to be photographed during activities with St. Ann’s Youth Ministry. I understand that said photos/videos may be used for future Youth Ministry publications within the St Ann’s Community and social media. *
I give permission for Youth Ministry Staff and volunteers to communicate with my teen via e-mail, phone calls, and social media. *
Please list any current medications.
Your answer
In signing this form, I the parent, certify that all information contained herein is true and accurate to the best of my knowledge. Please type your name. *
Your answer
Today's Date *
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