QUEST 18, a Program Sponsored by St. Joseph the Worker Church, Chatham

PERMISSION FORM

Dear Parent or Legal Guardian:

Your daughter/son has requested permission to participate in:

QUEST ‘18, a program sponsored by St. Joseph the Worker Church, Chatham

A description of the event follows:

NAME OF EVENT:QUEST ‘18

DATE(s) of EVENT:Sunday, February 18 – Monday, February 19

Time of EVENT:Drop Off Sunday - 6:00pm – Pick UpMonday Evening at 5:00pm

ACTIVITIES INVOLVED:Overnight retreat and Team building

Event Takes Place at:St. Joseph the Worker Church

Under the Supervision of:Riana and Wes Cattoor, Michelle and Brian Stenke and Janice and Rodger Anderson

Please be sure to have your child eat dinner before they come on Sunday night- only snacks will be provided that evening. Meals will be provided on Monday.

If you wish your child to participate in the above described event, please read, complete, sign, and return the following statement of consent and release of liability:

I request that my child be allowed to participate in “QUEST ‘18,” described above. I grant my permission for ______to attend this event and release and agree to indemnify and hold harmless St. JosephChurch and all persons connected with this event from any liability, claims, or damages for personal injury, or property loss or damage that may result during the event. My signature gives authorization to the above named entity to secure treatment for my child by emergency personnel in the event of an accident after reasonable effort has been made to reach me. I also grant permission for St. Joseph to publish photos of my child on its website () as she/he may be participating in this activity. I understand that names will not be posted on the website, only photos.

PLEASE COMPLETE AND RETURN THE ATTACHED HEALTH FORM WITH THIS PERMISSION FORM.

Signature of Parent/Guardian (If there are two custodial parents, both need to sign) DATE

Print parent/Guardian NamePHONE

AddressCity, State, Zip

Please Return Both Forms byFebruary 12th, 2017 You may drop forms off at St. Joseph’s (Manilla envelope on notice board, or turn into the office) or you can mail them to Quest at St. Joseph the Worker, 700 E. Spruce, Chatham, IL 62629