Jr. High & High School Kings Island Trip St.

Mary’s Youth Ministry Permission Slip Participant’s Name ________________________________ PARENT/GUARDIAN SECTION
I __________________________________ hereby give my permission for my child to attend the Jr. High and High
(Parent or Guardian Name)

Age ____________

School Kings Island trip hosted by St. Mary’s Youth Ministry on July 25th, 2012. I attest that the information on this form and the medical information provided on the Youth Ministry Information Form (this form can be found online at http://www.scribd.com/doc/99715401 ) is correct. I will not hold St. Mary’s or a volunteer driver responsible for injuries that occur on this trip.

Parent or Guardian Signature Parent Phone Number

Date ______________________

Home:__________________________ Cell:

Emergency Contact Name: _______________________ Relationship to child:_______________ Phone:_____________ Please include written permission for any medication, including over the counter items, in a plastic baggie to be collected before the event. _______ I will drop off my child at St. Mary’s office parking lot at 8:30 a.m. & pick up my child at St. Mary’s at 9:00 p.m. He or she has permission to ride with an adult driver to the event. _______ I will serve as a driver and chaperone for this event. I can take _______people in my vehicle (including myself). _______ My child will attend this event with me and/or other family members. ________We will drive separately. We will arrange to pick up our tickets before the event (call the office.) ________We will drive with the group. Please provide your child with enough pocket money for lunch and dinner at the amusement park. Swimsuits and towels are optional; we may visit Boomerang Bay Water Park if enough people want to go.

You are representing St. Mary’s Church and your family during this event. Mature and responsible behavior is expected at all times.

Expectations are:
     All participants are expected to arrive on time. All participants are expected to demonstrate courtesy, respect, and honesty. Dress should reflect the value of modesty. Possession/consumption of any alcoholic beverage and/or use of any illegal drug, including tobacco, is not permitted under any circumstances. Any prescription and/or over the counter medications need to be given to an adult for storage and distribution.

I understand and agree to this behavior code. I also understand and agree that my parents/guardians will be notified immediately in the case of an infraction which requires dismissal. My parents/guardian will be responsible for my removal from the premises.

______________________________________________ Youth Signature

____________________ Date

PAYMENT INFO I would like _________ tickets @ $25 each, for a total of __________.
# of tickets total dollars owed

Please pay with cash or check. Checks can be made payable to St. Mary’s Church. Call 663-8427 with questions.

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