Community Service Day 2021 Permission Form

  • Community Service Day is Friday, April 16, 2021.
  • Fill out and submit a separate form for each student
Student's Grade *

INSURANCE INFORMATION: (Both lines MUST be completed.)

Limitations: If there are any limitations and/or conditions that might affect your child's participation, please enter them below.

Medication: If medications are needed, please send them with your child. List these medications in the following section and include product name and physician's instructions on dosage and frequency. Any medications brought to the program should be clearly labeled in their original container and checked in at registration.

Participation Consent: I grant permission for my child to participate in the Community Service Day. I will not hold Bishop Chatard High School  place of service responsible in the event of any injury or accident to my son or daugher while participating in or traveling to and from the event.  I warrant that, to the best of my knowledge, my child is in good health and able to participate in all program activities. I've listed any limitations above.
    I agree that my child shall abide by all Bishop Chatard rules and policies. I have reviewed and discussed the rules and policies with my child prior to signing this form. I agree that if my child fails to abide by the rules/policies, or engages in a serious infraction, he or she may be immediately dismissed from the activity and sent home at my expense.  I agree to my child's participation in the Community Service Day.
     I understand that all prescription and non-prescription medication will remain in the possession of the adult team leader and be dispensed as prescribed. In case of medical emergency, I understand that every effort will be made to contact parents or guardians of participants. In the event that I cannot be reached, I hereby give permission to the Campus Ministry program directors to seek treatment for my son/daughter. I hereby give permission to the medical staff to hospitablize, secure proper treatment for, and to order injection, anesthesia, or surgery for my child.
    I understand that my child may be photographed, unidentified in groups situations; and I hereby grant permission for my child to be photographed and identified for releases to Bishop Chatard and the Bishop Chatard website and/or other promotions.
    I understand that, as situations change due to COVID concerns, other permission slips may be needed, as procedures require.
Consent: *
Use your mouse --or-- click and drag -- or -- use your finger on a touch screen to write your name below.
Written Signature *
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