Diocese of Grand Rapids - Squarespace

Diocese of Grand Rapids St. Pius X Parish Office of Youth Formation 4109 – 40th Street SW Grandville, Michigan 49418 Parent Permission Form for Youth Activities Dear Parent or Legal Guardian: Your child is eligible to participate in a St. Pius X Parish sponsored activity requiring transportation to a location away from the parish premises. This activity will take place under the guidance and supervision of chaperones from St. Pius X Parish. A brief description of the activity follows: Name of Event: Crossroads Rebounderz Destination: Rebounderz, 7500 Cottonwood Dr, Jenison, MI 49428 Date of Event: Sunday, October 23, 2016 Time of Event: 6:45-8:35 PM Method of Transportation: Please drop-off and pick-up students from Rebounderz Cost: 16 If you would like your child to participate in this event, please complete, sign, and return this entire form and payment by October 9, 2016. As parent or legal guardian, you remain fully responsible for the actions and conduct of your child.

Statement of Consent I hereby consent to participation by my child, , in the event described above scheduled for Sunday, October 23, 2016. I understand that the event will take place away from the parish grounds. I further consent to the conditions stated above on participation in this event, including the method of transportation. In consideration of my child being allowed to participate in this event, I agree to waive and release, and indemnify and hold harmless St. Pius X Parish, any and all affiliated organizations, its/their employees, agents, representatives, volunteers and drivers, from any and all claims I or my child may have, excluding claims for intentional misconduct or gross negligence, arising from or relating to my child’s participation in this event.

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