ATHLETIC

EVENT CONSENT AND RELEASE

My son/daughter __________________________ has my permission

to participate in parish

sponsored athletic events including but not limited to flag football,

soccer, volleyball, basketball, baseball/softball.

(410)

829-3669 Pastor’s cell phone – Father Carroll

(443) 786-2053

– Youth Minister’s cell phone – Brian Zedalis

¦

I understand that with any athletic activity there is a risk of injury.

¦

I understand that St. Benedict/St. Elizabeth Youth Ministry

may be responsible for transportation to and from the event

through carpools and that departure/return

times may vary based on previous agreement and communication among travelers.

¦

I also understand that participants will not be allowed to leave the event early

without a reason and call from their parent or guardian.

¦

I understand that my child will be chaperoned by responsible adults and that

he/she will be expected to abide by all rules stated in the Diocese of Wilmington

Code of Conduct as well as any additional rules as stated by the Office for

Catholic Youth Ministry.

¦

As parent/guardian, I understand that promotional pictures (individual and group) will be taken during this event. I give

permission for my sons/daughter’s picture to be used for promotional materials (newsletter, web page, calendars, power point,

etc.) in highlighting the event.

By my signing this, I release St. Benedict/St. Elizabeth Parish, its Youth Ministry Team, Drivers, and the Diocese of Wilmington from any and

all liabilities and waive all claims against them. I also give my permission for the aforementioned event coordinator and other qualified adults

to obtain proper medical treatment for my child should if become necessary.

Signature of Parent of Minor

Date

Insurance Carrier/Number

Emergency Contact Name/Phone Number

Medication Taken/Additional Instructions: