Trick-or-Treat for the Food Shelf!
Wednesday, Oct. 27th at 4:45 p.m. (Gather in Main Parking Lot of St. Anastasia Church)

Open to all students (Grades 6-12); Bring friends! (Must also have completed form before participating!)

Drivers & students will gather in parking lot at 4:45 p.m. sharp.  ALL students MUST have this online permission slip in before participating in this event!  

I will be in touch with all drivers prior to the day of the event to assign routes!  ADULT VOLUNTEERS GREATLY NEEDED!  Drivers, sorting, clean-up, etc.

I believe the event should wrap up around 8 p.m.  (Time may change!)

Sign-up no later than Friday, Oct. 22nd!  Pizza and St. A's youth group (until 9 p.m.) to follow!  

Contact me at youthmin@stanastasia.net or 320-484-4864 with any questions.  Thank-you.

Jake Burmis, Director of Youth Ministry
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Email *
Child's Full Name *
Child's Grade *
Parent/Guardian/Emergency Contact's Name *
Parent/Guardian/Emergency Contact's Phone Number *
Medical Insurance Provider *
I, the parent (guardian) of the above named child, hereby, give my permission for his/her participation in the youth activities named above.  I agree to direct my child to cooperate and conform to directions and instruction of St. Anastasia Catholic Faith Community personnel or volunteers responsible for such youth activities.I agree that in the event my child is injured as a result of his/her participation in the above named youth activities, including transportation to and from these activities, recourse for the payment of any resulting hospital, medical, or related costs and expenses will first be had against any accident, hospital, or medical insurance, or any available benefit plan of mine or of my spouse.  I understand that it is my responsibility to pay any co-pays to any medical institution or/and any balance not cover by any of the above mentioned. I am not aware of any medical condition of my child which would render it inappropriate for him/her to participate in any such activity.I, hereby, give permission to the physician selected by the youth activities supervisory personnel then present to render medical treatment deemed necessary and appropriate by the physician. *
Are you willing to be an adult driver for this event?  Must be 21+ years old; 2 adults needed per vehicle. *
If yes, please comment the # of YOUTH spaces that you will have in your vehicle (2 adult spaces).
Are you willing to be an adult volunteer that does NOT drive but stays at St. Anastasia and helps out in the gym?
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