image

image

SCHS Parent/Guardian Permission Slip
for Sophomore Retreat 2010
When you submit this form you will be taken to a secure on-line site to make your payment of $20.70 ($20 retreat cost, $.70 on-line processing fee.) If you wish to pay by check, please do NOT use this form. There is a link to a printable version of the permission slip at the bottom of this page.
Students Full Name:
A value is required.
Students Gender:
M F
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.A value is required.


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. Please note that there will be times when your child will be permitted to enjoy the camp area, go on walks, etc. in small groups within a reasonable radius of the main center without direct adult supervision.

A brief description of the activity follows:
  • Activity: Sophomore Retreat
  • Destination of Event: Girls - St. John Vianney Catholic Church; Boys - Camp Kitaki
  • Cost: $20.70
  • Date and Departure time: Tuesday, February 23rd, 7:50 am
  • Anticipated return time to Skutt Catholic: 4:00 pm
  • Method of transportation: Buses
  • Supervised by: Father Andrew Sohm, Julie Schmitz Campus Minister, designated faculty and volunteers, and selected seniors

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: (Format MM/DD/YY)

A value is required.Invalid format.

Emergency Contact Info (In the event a parent/guardian cannot be reached)

Name and Relationship: Phone: A value is required.Invalid format.

Family Doctor: Phone: A value is required.Invalid format.


YES! I want to help make the Sophomore Retreat successful! Please check below if you are interested in any of the following ways.  Thanks for volunteering!  You will be contacted with the details if your help is needed.

BOYS RETREAT
I would like to provide a dessert or a snack

GIRLS RETREAT

I would like to prepare and serve lunch.

I would like to come to St. John Vianney to pray for an hour for the girls and the retreat team. Please check your available times:







If any of the above are checked, please let us know the best way to reach you:

Please submit by Friday, February 5th.

Please note any questions, special medical concerns, or current medications here:



 

 

If you would prefer to pay by check, please click HERE to download the permission slip. Print and fill out the permission slip, then send it and a check to school with your student, attention Campus Ministry.



Contact us
image