PARENT PERMISSION FORM FOR FIELD TRIP PARTICIPATION Dear Parent or Legal Guardian: Your son/daughter is eligible to participate in a school/parish-sponsored activity requiring transportation to a location away from the school premises. This activity will take place under the guidance and supervision of employees from St. Lawrence School and/or Parish. Name of Event: St. Vincent De Paul Volunteering Destination: St. Vincent De Paul Store, 45550 Van Dyke Ave, Utica, MI 48317; (586) 323-5133 Designated Supervisor of Activity: Deann Reusche, Youth Ministry Coordinator. Emergency # 586-921-3747 th Date and Time of Departure: May 10 2014 volunteering from 12:00-3:00pm drop-off and pick-up by parents from St. Vincent De Paul Store Method of Transportation: NONE Student Cost: NONE If you would like your child to participate in this event, please complete, sign, and return the following statement of consent and release of liability. As parent or legal guardian, you remain fully responsible for the actions and conduct of your child. STATEMENT OF CONSENT I hereby consent to participation by my child, _________________________________________, in the event described above. I understand that this event will take place away from the school/parish grounds and that my child will be under the supervision of the designated school/parish employee on the stated dates. I further consent to the conditions stated above on participation in this event, including the method of transportation. In consideration of my child being allowed to participate in this field trip, I hereby agree on behalf of myself and my child, to release St. Lawrence School and/or Parish, the Roman Catholic (Arch)diocese of Detroit, and any and all affiliated organizations, their employees, agents and representatives, including volunteer drivers (collectively “Releasees”), from any and all claims, including negligence, which may be asserted by me or my child, or on behalf of my child, arising from or relating to my child’s participation in the field trip. In the event this release on behalf of myself and/or my child is held to be invalid or unenforceable, I hereby agree to indemnify and hold harmless Releasees from any and all claims, including negligence, which may be asserted by me or my child, or on behalf of my child, arising from or relating to my child’s participation in the field trip. This release of indemnification does not apply to claims for intentional misconduct or gross negligence; nor does this release or indemnification apply to the extent of commercial insurance coverage for any claim, but this Release or Indemnification shall apply to the extent of any self-insurance or deductible applicable to any claim. My child has the following medical conditions or allergies about which a health care provider should be told: ____________________________________________________________________________________ During this activity I can be reached at: (____)__________________ or (_____)__________________ _____________________________________________________________________________ Parent/Legal Guardian Printed Name Parent/Legal Guardian Signature Date rd Please return this entire form no later than May 3 2014 to the CRE Office marked Youth Ministry attn: Deann Reusche VOLUNTEER/COMMUNITY SERVICE AGREEMENT & WAIVER DATE: __________________ STORE LOCATION: _45550 Van Dyke, Utica MI___ (586-323.5133) VOLUNTEER NAME: _______________________________________________ (Print – first, middle initial and last name) DATE OF BIRTH: ____________________________________(month/day/year) ADDRESS:___________________________________ CITY/ZIP_______________________ PHONE NUMBER(area code):_____________________________EMAIL:___________________ SCHOOL: ST. LAWRENCE EVENT DATE:__________________________________________________________ (By signing below, I specifically authorize Society of St. Vincent de Paul, its agents and its employees to make inquiries of courts, law enforcement agencies and other entities for records of criminal convictions. I understand that it is the intent of the Society of St. Vincent de Paul to deny participation to any person who has been involved in or convicted of a criminal activity that may be harmful to the Society of St. Vincent de Paul, the activity or the participants.) I hereby acknowledge and accept that there are inherent risks involved in volunteer work. In consideration of this acknowledgement and my voluntary participation in activities relating to volunteering for the Society of St. Vincent de Paul, having read this waiver and understanding the risks involved in participating as a volunteer for the Society of St. Vincent de Paul and the agreement by the Society of St. Vincent de Paul to allow me to participate as a volunteer. I hereby release, on behalf of myself, and my successors, heirs, assigns, executors and administrators, the Society of St. Vincent de Paul, its officers, directors, members and volunteers from any claims of liability or demand whatsoever, including but not limited to bodily injury, sickness, disease, death, property loss or damage, or any other loss or damage of any kind which may arise out of or in connection to my participation in the Society of St. Vincent de Paul volunteer activities, whether resulting from negligence or from some other cause. I have read and understand the forgoing Waiver of Liability, and by signing below, I indicate my agreement. It is my intent to be legally restrained from asserting any claim connected herewith and I understand that this agreement is unconditional and my not be waived by any person for any reason whatsoever. **SIGNATURE:_____________________________________ DATE: _______________ **If you are under 18, a parent/guardian must sign the waiver. Age 16 younger must be accompanied by adult. Return completed form via fax: 313.393.3015; mail: 3000 Gratiot, Detroit, Michigan 48207; or at any SVdP store Questions: call Volunteer Coordinator @ 313.393.2936. Visit our website www.svdp.org