High School Lock-Out Permission Slip St.

Marys Youth Ministry Participants Name ________________________________ SCHEDULE OF EVENTS

4:30 5 :30 pm- Mass (Meet group in the loft to attend Mass together) 5:30 6:30 pm- Travel to Indianapolis 6:30 8:00 pm- Dinner @ Steak N Shake, Beech Grove 8:00 9:00 pm- Laser Tag (Expo Bowl, Laser Storm) 9:00 11:00 pm- Greatimes, Games & Go Karts 11:00 12:30 am- Return to Greensburg 12:30 2:30 am- Pool Party @ Allen Memorial Pool 2:30 6:30 am- Movie & Games @ St. Marys Ed. Bldg 6:30 7:00 am- Breakfast (Parents need to pick up their youth from the Ed Bldg at 7:00 am or arrange a ride home with someone else)

Age ____________ PAYMENT INFO

This event costs $30, which includes GreatTimes, laser tag, the pool party, and breakfast. This fee is payable by cash or check (made out to St. Marys Church). Please bring pocket money for dinner. Financial Assistance is available for those who need it, contact Tanya for more information.

PARENT/GUARDIAN SECTION
I __________________________________ hereby give my permission for my child to attend the High School Lock-Out hosted by St. Marys Youth Ministry on July 21st and 22nd 2012. I agree to let them go to all the locations (see Schedule) that this event entails. I attest that the information on this form and the medical information provided on the Youth Ministry Information Form (this form can be found online at http://www.scribd.com/doc/99715401 ) is correct. I will not hold St. Marys or a volunteer driver responsible for injuries that occur on this trip.

__________________________________
Parent or Guardian Signature Parent Phone Number

____________________
Date ______________________

Home:__________________________ Cell:

Emergency Contact Name: _______________________ Relationship to child:_______________ Phone:_____________ Please include written permission for any medication, including over the counter items, in a plastic baggie to be collected before the event. _______ I will drop off my teen at St. Marys for Mass at 4:30 p.m. and pick my teen up at 7:00 a.m. from the St. Marys Parking Lot, or allow them to drive to the event themselves. I give my permission for him or her to ride with a volunteer driver age 18 or older during the event. _______ I will serve as a driver and chaperone for this event. I can take _______people in my vehicle (including myself).

YOUTH SECTION
_______ I will be present for the entire eventfrom 4:30 p.m. until 7:00 a.m. ($30) _______ I will join the group at the Pool party at 1:00 a.m. and remain until 7:00 a.m. ($15 fee)
You are representing St. Marys Church and your family during this event. Mature and responsible behavior is expected at all times.

Expectations are:
All participants are expected to arrive on time. All participants are expected to demonstrate courtesy, respect, and honesty. Dress should reflect the value of modesty. Possession/consumption of any alcoholic beverage and/or use of any illegal drug, including tobacco, is not permitted under any circumstances. Any prescription and/or over the counter medications need to be given to an adult for storage and distribution.

I understand and agree to this behavior code. I also understand and agree that my parents/guardians will be notified immediately in the case of an infraction which requires dismissal. My parents/guardian will be responsible for my removal from the premises.

______________________________________________ Youth Signature

____________________ Date