Participant’s Name: _________________________________________

Parent/Guardian’s Name: _____________________________________

Home Address: _____________________________________________

Home Phone: ________________ Business Phone: ____________

I grant permission for my child __________________________________ to participate in this parish event that requires transportation to a location away from the parish site. This activity will take place under the guidance and direction of Confirmation volunteers from Sacred Heart.

Type of event: Confirmation Retreat - Meier Lake Retreat Center

Date and estimated length of event: Oct. 15 - Oct 17, 2010           9:30am - 12:00

Retreat Fee: $75.00

Destination of event: Meier Lake Retreat Center - Mile 6.8 Wasilla Fishhook

Individual in charge: Scott Gunnell, Val Lindeman, Bob Fox, Mary Fox

As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor (participant)

I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend Sacred Heart Parish, its officers, directors and agents; and the Anchorage Archdiocesan chaperones or representatives associated with the event, arising from or in connection with my child attending the event or in connection with any illness or injury or cost of medical treatment in connection therewith, and I agree to compensate the parish, Its officers, directors and agents and the Anchorage Archdiocesan, chaperone or representative associated with the event for reasonable attorney’s fees and expenses arising in connection therewith.

Signature: _____________________________ Date: ________________