Diocese ______________________ Parish _____________________ School ______________________

Dear Parent or Legal Guardian:

Your son/daughter, guardianship, is eligible to participate in a ___________________________ -- sponsored activity that requires transportation away from the _____________________________site. This activity will take place under the guidance and supervision of employees from ____________________________________________.

A brief description or the activity follows:

Curriculum Goal _________________________________________________________________________

Destination _____________________________________________________________________________

Designated Supervisor of Activity ___________________________________________________________

Date and Time or Departure ________________________________________________________________

Date and Anticipated Time of Return _________________________________________________________

Method of Transportation __________________________________________________________________

Youth Cost ______________________________________________________________________________

If you would like your child to participate in this event, please complete, sign, and return the following statement of consent and release of liability.

Name: _________________________________________________________________________________

has my permission to attend the _____________________________________________________________

on _____________________________ in _____________________________________________________.

It is understood that reasonable precautions will be taken by those persons in charge to prevent accidents or injuries, but neither those in charge nor those bringing groups shall be held responsible in case of accident or injury .I also understand that if my child violates any of the Rules of Conduct, a copy of which is attached hereto, I/we will be called to pick up the child. As parent, or legal guardian, I/we remain fully responsible for any legal responsibility that may result from any personal actions taken by the named child.

I/We hereby consent to participation by my/our child, ____________________________________________,

In the event described above. I/We understand that this event will take place away from the ______________

________________________________________ and that the child will be under the supervision of the designated diocesan/school/parish employee on the stated dates. I/We further consent to the conditions stated above on the participation in this event, including the method of transportation.

_________________________________________     ____________________________________________

Parent/Legal Guardian Signature                                             Parent/Legal Guardian Signature

_________________________________________    ____________________________________________

Address                                                                                     Address

_________________________________________    ____________________________________________

Emergency Telephone Number                                             Emergency Telephone Number

Please return this entire for by: ___________________________________________