Type of Event: High School Late Night

When: Saturday, March 7 from 4:00pm-12:00am

Location: St John the Baptist Catholic Church and School (Enter Door #1)

Individual In Charge: Coordinator of Youth Evangelization - Kristina Benson (with assistance of participating youth ministers)

Mode of Transportation to and from event:  Parent drop-off and pick-up at St John's

Cost: $25
- Prepare for Chipotle and an Ice Cream Bar!

I grant permission for my child to participate in this parish event.  This activity will take place under the guidance and direction of parish employees and/or volunteers from St John the Baptist Catholic Church (Savage), St. Michael's Catholic Church (Prior Lake), Mary Mother of the Church Catholic Community (Burnsville), Nativity of Mary (Bloomington), Risen Savior Catholic Community (Apple Valley), St. Joseph (West Saint Paul), St. Joseph (Rosemount), Sts. Joachim and Anne Parish (Shakopee), and all other participating parishes.

I understand and agree that as a parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor ("student/participant").  Further, I hereby warrant that to the best of my knowledge, my child is in good health and assume all responsibility for the health of  my child.  

I agree on behalf of myself, my child named herin, or our heirs, successors, and assigns, to hold harmless and defend  St John the Baptist Catholic Church (Savage), St. Michael's Catholic Church (Prior Lake), Mary Mother of the Church Catholic Community (Burnsville), Nativity of Mary (Bloomington), Risen Savior Catholic Community (Apple Valley), St. Joseph (West Saint Paul), St. Joseph (Rosemount), Sts. Joachim and Anne Parish (Shakopee), and all other participating parishes, their officers, directors, employees and agents, and the Archdiocese of Saint Paul and Minneapolis, its employees and agents, chaperones, or representatives associated with the event and activities (herinafter "Releases"), from any claim, including but not limited to all claims relating to communicable disease, arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate Releasees for reasonable attorney's fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of Releasees. 

Communicable Disease Release, Hold Harmless & Indemnification Agreement:  I agree to hold Releasees harmless, release, defend, and indemnify Releasees for any communicable disease claim arising out of the above Event that is brought against Releasees by myself, participant, my family members, heirs, assigns, executors, and personal representatives. I understand and agree this communicable disease release, hold harmless, and indemnification agreement includes claims based on the actions, omissions, or negligence of participant, myself and others, including, but not limited to the Releasees.

In the event of an emergency, I herby give permission to transport my child to a hospital for emergency medical or surgical treatment.  In the event of an emergency, if you are unable to reach me at the above numbers, contact:

Medications:  My child is taking medication at present.  My child will bring all such medications necessary and such medications will be well-labeled. St John the Baptist Catholic Church (Savage), St. Michael's Catholic Church (Prior Lake), Mary Mother of the Church Catholic Community (Burnsville), Nativity of Mary (Bloomington), Risen Savior Catholic Community (Apple Valley), St. Joseph (West Saint Paul), St. Joseph (Rosemount), Sts. Joachim and Anne Parish (Shakopee), and all other participating parishes Staff will not dispense medications.  If medications are required during program, it is the responsibility of the parent, or child (if age appropriate) to administer.  All medications will be properly stored during the day. Names of medications and concise directions for seeing that the child takes such medications, including dosage and frequency of dosage, are as follows: