Middle School Laser Tag Permission Form

 

Permission Slip:              Middle School Laser Tag

Sunday, Nov. 4 after the 10:45 Mass at St. Elizabeth

Xtreme Craze

Westmeadow Plaza   166 Milk Street   Westborough, MA 01581

Bus leaves St. Elizabeth parking lot at 12:00 noon after the 10:45 Mass

Bus pick up at St. Isidore lot: 12:15 PM

Returns to St. Isidore @ 4:00 PM

Returns to St. Elizabeth @ 4:15 PM

 

Please check where your child will be picked up and dropped off.

 

          _____ St. Elizabeth                                                  _____St. Isidore

 

Cost: $45. Checks should be made out to SEOH.

This includes 2-4 game sessions of Laser tag, 20 tokens, 2 pieces of pizza, unlimited soft drinks, and bus.

If there is room, kids may bring friends who do not go to these churches.

Please send or drop off forms and checks.  They will be processed on a first-come, first-served basis.

Barbara Dane

Apple Valley Catholic

89 Arlington St.

Acton, MA 01720

St. Elizabeth of Hungary Parish—Activity Form

I/we, the parent(s)/guardian of ______________________________________________, give my/our permission for him/her to participate in the Xteme Craze trip on Nov.4.

I/we the undersigned hereby release and hold St. Elizabeth and St. Isidore parishes, their agents and chaperones from any liability arising out of or from injuries received or caused by my/our child or by emergency care provided to my/our child.

If in your judgment, my/our child needs emergency medical care, you are hereby authorized to take such action as may be needed to stabilize my/our child until I/we can be reached.

I/we do/do not give permission for chaperones to dispense aspirin, acetaminophen, and similar non-[prescription medicines to my/our child when he/she seems to need them. If the child needs to take prescription medication, or if he/she has any medical condition that the chaperones or emergency medical personnel need to be aware of, please give the details here. Use the back of the form, if necessary.

In case of emergency, please call:   

Name ______________________________

Phone:_____________________________                   

Cell: ______________________________

Child’s physician: _____________________________ Phone: ___________________________

Signed:  ______________________________________

Date:  ____________________________

             (parent or guardian)

Email for confirmation and/or weather related information: ______________________________

____ Yes. I would be willing to chaperone.  

CORI Form ____                         Virtus Training _____

 

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