image

image

 
SCHS Parent/Guardian Permission Slip
for Community Involvement Day 2010
On Wednesday, October 6, 2010, Skutt Catholic students and faculty will again participate in Community Involvement Day. As a wonderful tradition, students go out into the community to learn about people and agencies that are serving others, and then provide service themselves. The students will go with their advisement and faculty/staff member or parent volunteer to Head Start programs, nursing homes, sites for the disabled, and many other locations, transported by parents, faculty members, or other adults. Please read the following consent form & liability waiver completely, fill in all the information, and submit it by Thursday, September 23rd, 2010.

PARENTS: If you are willing and available to help drive the students in your son/daughter's advisement either one way or both ways, please check below or contact your advisor. The times are approximately 8:25 am (beginning with a meeting with Patrick Slattery in the Media Center,) and 1:15 pm leaving the site. You are also welcome to stay with the advisement and serve at the site. Thank you for your help and prayers for a successful and rewarding day.
Students Full Name & Grade:
A value is required.
Students Advisor:
A value is required.
Parent/Guardian's Name:
A value is required.
Email:
A value is required.Invalid format.
Home Phone:
A value is required.Invalid format.
Secondary Phone (Please check what type of phone):
Invalid format.


By typing your name below and checking the "I Consent" box, you agree that:

I hereby consent to participation by my child in this school-sponsored event that requires transportation to a location away from the school site. This activity will take place under the guidance and direction of school employees and/or volunteers from Skutt Catholic High School. A brief description of the activity follows:
  • Activity: Community Involvement Day
  • Destination of Event: Various local service sites
  • Date and Departure time: Wednesday, October 6, 2010, 8:45 am approximately (parent driver meeting at 8:25 am)
  • Anticipated return time to Skutt Catholic: 1:40 pm (approximately)
  • Method of transportation: Vehicles of parents, faculty members, other adults

As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor ("participant").

I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend Skutt Catholic High School, its officers, directors, and agents, and the Archdiocese of Omaha, chaperones, or representatives associated with the event, from any illness, injury, or cost of medical treatment, arising from or in connection with my child attending the event described above, that is not the result of intentional neglect or willful or wanton misconduct by the school, its agents, representatives or employees.

Medical Matters: I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor.

I consent to the above stipulations. Please make a selection.

Parent/Guardian Full Name: A value is required.

Date:

A value is required.Invalid format.


Yes, I want to help make CID very successful! I am able to help drive. (Please check when you are available below. Your student's advisor will contact you with the details.)

Morning (approx. 8:25 am, beginning with parent meeting)
Afternoon (approx. 1:15 pm)
Both

If my student's advisement group has enough drivers, I would be willing to drive for another advisement.


PLEASE MAKE SURE YOUR STUDENT READS AND AGREES TO THE FOLLOWING:

I am a representative of V.J. and Angela Skutt Catholic High School. I will conduct myself in a manner which will reflect a positive image of myself and the school.

My student has read and agreed to the above statement.
A value is required. Parents Initials


Comments, questions, or special medical concerns:



 

 

If you would prefer to download the permission slip and send it in with your student please click HERE.



Contact us
image