Special Event Permission Slip

* Indicates required field

Participant's Name *

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This youth will participate in: *

5th/6th Grade - 3/1/20 5th/6th Grade - Random Acts of Kindness throughout Chandler 7th-8th Grade -Feed Our Babies at 3313 N 40th St, Phoenix, AZ 85018 on 1/5/20, 2/2/20, 3/1/20, 4/5/20, 5/3/20 - High School -PB&Jesus - Central Phoenix on 1/5/20, 2/2/20, 3/1/20, 4/5/20, 5/3/20 CONFIRMATION RETREAT -April 4-5 at 3220 Old Country Rd, Pine AZ

Additional Participant's Name *

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Additional Participant's Name *

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This youth will participate in: *

This Youth will participate in: *

PARENT/GUARDIAN'S Name *

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Does the participant have the permission of the custodial parent or legal guardian to attend this event? *

Yes No

By clicking below, I certify that I have completed the required "hardcopy" annual permission slip and have given it to the Director of Youth Ministries, Kadi Strong, and I understand if this is not done, my child is NOT eligible to participate in any events . *

Yes No - I am a guest

By clicking below, I affirm that my child's medical/insurance information is correct on their annual permission slip, and if for any reason it changes, I understand it is my responsibility to update that information immediately with the Director of Youth Ministries, Kadi Strong. *

Yes No - I am a guest

FOR GUEST PARTICIPANT'S ONLY - I give permission for my child to receive medical treatment if deemed an emergency by the event leaders. I also assume all medical costs incurred from this treatment. *

Yes - Please treat my child No - Do not allow any medical treatment

By electronically signing below the participant (or parent/guardian if participant is a minor) acknowledges and accepts the risks of physical injury associated with participation in the activity described above. Except for gross negligence on the part of Saint Matthew's and the sponsor, the participant (or parent/guardian) accepts personal financial responsibility for any bodily or personal injury sustained during the activity. Further, the participant (parent/guardian) promises to hold harmless the sponsoring organization and it representatives for any injury related to all Saint Matthew's Children and Youth activities from August 1, 2018 - July 31, 2019. If a dispute over this agreement or any claim for damages arises, the participant (parent/guardian) agrees to resolve the matter through a mutually acceptable arbitration process. I agree to the terms of this Permission Slip and certify that I am the parent or guardian of the participant by typing my name here: *

EVENT PERMISSION SLIP