Permission Form

Everyone....a permission slip is attached. I do not have everyone's email so if you want to send it to me via the address below I will make sure you get a form. Also I will have them at mass and at the church. See you Saturday. Mr Matt 781-1856 majorskirm@gmail.com

CYO Permission Form
Event: _______________________________________________

Child’s Name:________________________________ Age: ____________
Parent(s): ___________________________________ Phone#: ______________
Address: __________________________________
__________________________________
Primary Care Facility: _____________________________________
Allergies / Special Needs:
________________________________________________________________
________________________________________________________________
2nd Child
Child’s Name:________________________________ Age: ____________
Allergies / Special Needs:
_________________________________________________________________
_________________________________________________________________
Remarks/Comments:
_________________________________________________________________
_________________________________________________________________
Consent to this event allows the CYO staff to act as temporary guardian in the interest of the child in case of emergency or incident. Parents or caregiver will be contacted immediately.
Neither the Hickam Chapel staff nor Parrish staff will be held responsible for incidents resulting from your child’s or the other children’s actions while attending the event.

Parent or Guardian Signature: _________________________________________________