Permission Slip - National Catholic Youth Conference 2023

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Permission Slip - National Catholic Youth Conference 2023 - "FULLY ALIVE"

The National Catholic Youth Conference (NCYC)- FULLY ALIVE 2023

will take place November 16-19, 2023.

Cost

PARISHIONER= $400.00

NON PARISHIONER= $506.00

Please submit information below for St. Paul Parish records.

If you have more than 1 child attending, add to list at proper sections.

To help raise funds for the conference, feel free to use this as a template. SAMPLE SPONSOR LETTER

Thank you.

Name of Student(s) and Grade for school year 2023-2024 Ex. Michelle May 9th grade, Tim May 12th grade *

Cell phone # of student(s). If more than one child, please be sure to label which child has which phone number: Ex. Michelle 330-123-9876

Mother/Guardian name *

Cell phone # of Mother/Guardian *

Name of Father/Guardian *

Cell phone # of Father/Guardian *

Name of emergency contact if parent/guardian is not able to be reached. *

Cell phone # of emergency contact *

Check all that apply

Wheelchair access

Mobility impaired

Blind

Visually impaired

Hearing impaired - interpretation needed

Hearing impaired - interpretation NOT needed

I, the parent/guardian, grant permission for my daughter/son to participate in the National Catholic Youth Conference November 16-19, 2023. By allowing my child to participate in the said program, I hereby assume all risk of accident or harm arising or growing out of, directly or indirectly, any incident of any kind occurring during the course of such program to my child and do hereby release and discharge the Bishop of the Diocese of Youngstown, and St Paul Parish and the agents, associates, and employees of the Bishop and parish who have organized or participated in the supervision of such program from all claims, demands, suits, causes or actions, rights, costs, expenses, and any compensations whatsoever which may occur to my family and its members during or resulting from participating in the program mentioned. *

I agree

I am aware of the particulars of the said program including the times, costs, and adults chaperoning and/or transporting my child for the program and have clarified any concerns I may have with the coordinating adult in charge. I agree that my son/daughter shall abide by the rules and all regulations of the program including in regards alcoholic beverages, drugs, tobacco, and weapons. I agree that if my son/daughter fails to abide by the regulations set forth, he/she may be dismissed from the program and I will need to arrange for his/her immediate transportation home at my expense. *

I agree

I understand that photographs or video taken at this event may be used in parish or diocesan or national publications. *

I agree

I do NOT agree

In the event of an emergency: Please only select one: *

In the event of an emergency, I hereby grant permission to transport my son/daughter and obtain emergency medical or surgical treatment from a licensed physician, hospital, or medical clinic. I hereby authorize medical personnel to release necessary information about his/her care to the parish or school group leaders(s). I wish to be advised prior to further treatment by the hospital or doctor.

I hereby warrant that to the best of my knowledge, my son/daughter is in good health. I do not want any medical treatment to be given to my son/daughter under any circumstances. I hereby assume all responsibility for the health and well being of my son/daughter and release from responsibility the Bishop of the Diocese of Youngstown, and St Paul, and the agents, associates, and employees of the Bishop and parish who have organized or participated in the supervision of such program.

I hereby grant permission for nonprescription medication (such as acetaminophen, decongestant, cough syrup, cough drops) to be given to my son/daughter, if requested by my son/daughter and deemed advisable by an adult chaperone. *

Yes

I wish to inform you of the following additional medical information and the recommended course of action. (allergies, dietary restrictions, special conditions, etc.)

Please name which child(ren) is/are taking medications at present. He/she will bring all necessary medications and such medications will be well labeled. The names of and the concise directions for taking such medications, including dosage and frequency of dosage as follows.

I would like to have a member of the program staff speak with me further regarding a medical concern or situation.

Please enter the name of the parent/guardian who filled out this form.

By checking the box below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge. *

Click here to effectively provide your signature.

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