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P E R M I S S I O N F O R M Junior Youth Ministry
Dear Parent or Legal Guardian: Your son/daughter is eligible to participate in a parish wide-sponsored activity. This activity will take place under the guidance and supervision of St. Agnes, St. Elizabeth Ann Seton and Immaculate Conception Parish Adult chaperones. A brief description of the event follows.
NAME OF EVENT: “Bingo” at Briarcliff Pavilion
LOCATION: 249 Maus Drive N. Huntingdon, PA 15642
DATE: Wednesday, November 5, 2008
TIME: 6:45 – 8:00 PM (meet in large parking lot by entry door)
OTHER: ***Bring one or two Dollar Store items for the resident’s prizes…they love small soft stuffed animals, white low cut socks, hand lotions, seasonal decorations for their door or dresser etc…NO FOOD ITEMS OR CANDLES PLEASE! ***Bring permission slip with you to participate… ***Must call to reserve a spot - Mary Blythe 724-864-5393 limited number can participate ***ADULT HELP IS WELCOME…If you are staying let Mrs. Blythe know!
QUESTIONS: Call…Mary Blythe 724-864-5393, Sr. Charlene 724-864-6364, Ginny McConnell 724-863-9550
If you would like your child to participate in this event, please complete, sign and return the following statement of permission. As a parent or legal guardian, you remain fully responsible for any legal responsibility that may result from any personal actions taken by the named child.
I hereby consent to the participation by my child, ________________________________________ in the event described above. I understand that this event will take place away from parish grounds and that my child will be under the supervision of St. Agnes, St. Elizabeth Ann Seton and Immaculate Conception Parish parent chaperones on the stated date. I further consent to the conditions stated above on participation in this event.
In case of an emergency, please contact us at this phone number: _______________________________
I/We are unavailable contact (Name) _______________________________________________________________
(Phone) ______________________________________________________________
__________________________________________ Print Parent’s Name
__________________________________________ Parent’s Signature
__________________________________________ Date |