5K Walkathon Parental Permission Form
*Please submit one form per student*
We invite your child to attend a walking field trip to Golden Gate Park on Friday, October 24, 2025 from 1pm to 3pm as part of St. Anne's 5K Walkathon fundraising event. If you would like your child to attend this fun event, kindly fill and submit this form by Thursday, Oct 10, 2025.
If you have any questions, please email stanne5kwat@gmail.com
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Email *
Student's Name (First) *only one student* *
Student's Name (Last) *only one student*
Student's Grade *
Address *
Phone *
Birth date (MM/DD/YYYY) *
Parent / Guardian's Name *
Relationship to student *
Address (if different from above)
Phone (if different from above)
Emergency contact (other than parent) *
Emergency contact's phone *

I, the parent/guardian of the above-named child, herby, give my permission for his/her participation in the activity named  above. I agree to direct my child to cooperate and conform the directions and instructions of the parish, school or  Archdiocesan personnel responsible for the activity.

*
Required

I agree to the extent permitted by law, that in the event my child is injured as a result of his/her participation in the above-  named activity, including but not limited to transportation to and from the activity, whether or not caused by the negligence  (active or passive) of the parish/school or Archdiocesan youth activities program, or any of its agents or employees, recourse  for the payment of any resulting hospital, medical or related costs and expenses will first be had against any accident, hospital  or medical insurance, or any available benefit plan of mine or of my spouse.

*
Required

I am not aware of any medical condition of my child that would render it inappropriate for him/her to participate in any such activity.

I hereby, give permission to the physician selected by the youth activities supervisory personnel then present to render  treatment deemed necessary and appropriate by the physician.

*
Required

Further, I hereby waive any and all rights to, or compensation for, any photographs, videotapes, motion pictures, recordings,  or any other record of this event or activity, which may be made by the Archbishop/Parish/School/Agency and affiliate  organizations.

*
Required
Please type your full name to show that you agree and give permission for student to attend the event. *
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