Mini-Pilgrimage to LaCrosse, WI Permission Form/ Liability Waiver

I give permission for my child _______________________________ to take part in the Mini-Pilgrimage trip to La Crosse Wisconsin to the Shrine of Our Lady of Guadalupe and the Holy Hour for Vocations. This event requires transportation to locations away from the parish premises. Name of Event: Mini-Pilgrimage to the Shrine of Our Lady of Guadalupe and Diocesan Center

Destinations: Shrine of Our Lady of Guadalupe and Holy Cross Diocesan Center of LaCrosse in LaCrosse, WI

Designated Supervisors: Matthew Edens

Dates/Times: Monday, July 6th – Leave St Francis Church at 1:00pm, return approx 10:15pm

Method of Transportation: Car

Cost: A few dollars for dinner(Subway/Culver’s/etc)

I assume all risks and hazards incidental to participation and hereby release, absolve, indemnify and agree to hold harmless

the Diocese of Winona, MN, St. Francis of Assisi Church, Rochester Catholic Churches, its agents, employees and the chaperones, leaders, organizers and sponsors of this activity. Neither the Diocese of Winona, MN, St. Francis of Assisi Catholic Church, Rochester Catholic Churches nor any of said persons shall be held financially responsible for any injury, illness or death incurred as a direct or

indirect result of this activity.

I, the undersigned, have read this release and understand all its terms and execute it voluntarily and with full knowledge of significance. In the event of an emergency and I cannot be contacted, I hereby authorize that emergency treatment may be

administered.

Parent Name (please print) _______________________________________ Parent Signature: ___________________________________Date: _______________ Parent Phone: ___________________ Cell Phone : _________________________ Emergency Contact: __________________________Phone: ___________________ Please list any special circumstances regarding your child (food allergies, etc.). ____________________________________________________________________________________________________________________________________________________________________________________________________

Please add my email to the Youth Group List to receive notices on upcoming youth events for my child. Yes___ No ___ email: _________________________________________

Questions? Please contact Matthew Edens, Youth Ministry Coordinator, at 288-7313, or youthminister@stfrancis-church.org

http://stfrancis-church.org/youth-ministry

I give my consent for my child(ren) listed on this form to be photographed with the understanding

that these photos may be used anonymously in parish promotional publications.

Yes___ (Initials) No ____ (Initials)

Yes _____ No_____ Parent Initials:_______