Custom Social Media Facebook Phone Email

Youth Permission Form

- Events/Bulletins

Permission Form

For Voces Teen (Youth Group) Outing to watch Carlo Acutis Movie

Tuesday April 29th
Parents are to drop youth off at Goldstream Regal Movie theater at 6:45pm
Pick up when movie is done (around 9pm)
This form is not accepting responses at this time.
- How many children are participating? REQUIRED Please fill out this field.
  
  Child 1
  
  Name of Participating Child Please enter valid data.
  
  Birthdate Please enter valid data.
  
  Child 2
  
  Name of Participating Child Please enter valid data.
  
  Birthdate Please enter valid data.
  
  Child 3
  
  Name of Participating Child Please enter valid data.
  
  Birthdate Please enter valid data.
  
  Child 4
  
  Name of Participating Child Please enter valid data.
  
  Birthdate Please enter valid data.
  
  Child 5
  
  Name of Participating Child Please enter valid data.
  
  Birthdate Please enter valid data.
  
  Child 6
  
  Name of Participating Child Please enter valid data.
  
  Birthdate Please enter valid data.
- Parent Information
  
  Name of Parent Please enter valid data.
  
  Phone Number Please enter valid data.
- Emergency Contact
  
  Name of Emergency Contact Please enter valid data.
  
  Phone Number Please enter valid data.
- Release Agreement
  
  As parent or guardian of my son/daughter, I do hereby agree to allow my son/daughter to participate in the following activity:
  
  Outing to Goldstream Regal Movie Theater to watch the Carlo Acutis Movie. Tuesday April 29th, 6:45pm drop off. Pick up around 9pm
  
  In consideration of the opportunity for my son/daughter to participate in the activity, the receipt and sufficiency of which are acknowledged, I knowingly and voluntarily on behalf of myself and my minor child do hereby agree to forever RELEASE, HOLD HARMLESS AND INDEMNIFY Immaculate Conception Parish, the Office of Youth & Young Adult Ministry, the Catholic Bishop of Northern Alaska and his successors, a Corporation Sole, and all their affiliate organizations, and respective agents, employees, officers, directors, volunteers, and any officials, referees, and other participants (the Released Parties) from any liability, claims, demands and causes of action arising out of or relating to any loss, damage or injury (including death) sustained in connection with or arising out of my son/daughter's participation in the activity. By my consent below, I acknowledge that my child’s participation in the activity involves inherent risk of minor or serious injury, including permanent disability, death, and/or economic losses which might result from my child’s actions or inactions, the negligence of others, the inherent risks of the activity, the rules of play, the condition of the premises, or of any equipment used. I have voluntarily elected to allow my child to participate, and I fully understand, appreciate, and hereby assume all such dangers and risks.
  
  I understand that my child’s participation in said activities may require a minimum level of fitness for safe participation, and that the Released Parties do not screen, medically or otherwise, individuals that participate in the activity. I acknowledge that it is my sole responsibility to make certain that my child is physically fit and healthy enough to participate in the activity.
  
  Videography and Photography
  Parents/guardians of participants are advised that photographs or videotape of participants may be used in publications, websites or other materials produced from time to time by the parish/school, Office of Youth and Young Adult Ministry or the Diocese of Fairbanks. (Participants will not be identified, however, without specific written consent.). Parents/guardians who do not wish their child(ren) to be photographed or filmed should so notify an activity staff member. Please note that the Released Parties have no control over the use of photographs or film taken by media that may be covering the event in which your child(ren) participate(s).
  
  Medical Information
  I understand that the Released Parties do not provide medical treatment or medical, health or other insurance coverage for my child, however, I hereby grant permission for any staff member of the activity to obtain medical care from a licensed physician, hospital, or medical clinic for my son/daughter in the event that I cannot be reached.
  
  I am a legal parent or guardian and I agree and consent to the information I have read above REQUIRED Yes, I agree Please fill out this field.
  
  Digital signature (please type your name) REQUIRED Please fill out this field. Please enter valid data.
Submit

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Immaculate Conception Church

Fairbanks, AK

Youth Permission Form

Permission Form