St. Benedict / St. Elizabeth
Youth Ministry
P.O. Box 459 • 408 Central Avenue • Ridgely, Maryland 21660
EVENT SPECIFIC CONSENT AND RELEASE
My son/daughter __________________________ has my permission
to attend your parish’s Youth Ministry Trivia Night
on Friday, May 9th from 7:00pm
–
9:30pm
at the Emerson House in Denton, MD
(443) 786-2053
– Brian Zedalis’ cell phone
¦
I understand that I will be responsible for transportation to and from the event.
¦
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:
St. Benedict’s/St. Elizabeth’s Youth Ministry exists to praise God in ways that are
meaningful to our youth, to connect them to our parish family, to encourage them
as they
engage and explore their Catholic faith, to be Christ to others,
and to share their God-given gifts as they evolve into committed Catholic Christians.
