Catholic Diocese of Evansville

St. John the Baptist Church/School

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Youth Name	Date(s) of event

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Estimated Departure Time	Estimated Return Time

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Cost of Trip	Method of Transportation

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Dress for Trip	Grades attending

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Description of Activity or Event (Including Educational Purpose)

I, the parent of the above-named child, he/she be permitted to attend and participate in the above-described activity or event (“event”). I give my approval for my child’s participation in the event and agree to assume all risks and hazards incidental to the conduct of the event including transportation to and from the event. I do further hereby waive, release, absolve, indemnify and hold harmless the Bishop of the Catholic Diocese of Evansville,

St. John the Baptist Parish, Rev. Joseph Ziliak, Pastor, and any of their respective affiliates, successors, agents, employees, members, and representatives, adult sponsors, and other volunteers involved with the event including transportation associated therewith from any and all claims, including claims of personal injury to my child or property damage, under any theory of law (including negligence, but not reckless or intentional conduct) in any way resulting from or arising in connection with the event and/or transportation to and from the event.

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Date	Custodial Parent’s Signature

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Date	Guardian’s Signature

September 2002