Event Permission/Liability Waiver

Event:_____________________________

Date of Event:_______________________

Student:____________________________                     

Phone number:_______________________

Other Emergency Numbers:_____________

Grade:_____________________________

I, _________________________________ give my permission for my child to participate in the above mentioned event with St. Thomas Aquinas Center, West Lafayette, IN.  I understand that every effort will be made to protect the well being of my child, but agree that in the case of accidental injury, I will hold St. Thomas Aquinas Center and the adult sponsors of the trip harmless from any damages.  In any case that transportation may be needed, I understand that my child will be assigned to ride with a licensed driver, driving a privately owned or rented automobile.

In the event that my child would need emergency medical treatment, I give permission for the adults in charge of the group to secure the necessary treatment to protect the life and health o my child.  I understand that I will be contacted before any medical treatment is begun except where a delay in treatment would not be in the best interest of my child.

Child Signature:_______________________________ Date:_______________

Parent/Guardian Signature:_______________________ Date:_______________

Accident/Hospitalization Policy Name:__________________________________            

Policy Number:_______________________

Special Medical information that should be noted:__________________________            

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