Saint Catherine Academy Student Permission Slip

Name of Student: _________________________Homeroom:___________________

Activity:______________________________________________________________

Date of Activity: _______________________________________________________

Destination____________________________________________________________

I hereby request that my daughter attend the above mentioned activity. I do understand
that the mode of transportation is by foot, school bus, public transportation, private
vehicle. (circle one)

Allergies: ______________________Medical problems:________________________

Other Comments:______________________________________________________

Parent Name: ________________________Parent Signature:___________________

Parent Contact #: ______________or _______________Date:___________________

(It is expected that SCA and its faculty will exercise all reasonable and due care and attention
for students while on this trip. SCA and its faculty and staff members are hereby released
from any liability arising from such activity as a consideration for student’s participation.)