Saint Susanna High School Youth Ministry
PERFECT NORTH SKI TRIP
Thursday, January 3, 2012
COST: $60 Check made out to St. Susanna
This form and money MUST BE signed, completed, and turned in on or before Friday, December 21.
WE ARE MEETING in the Saint Susanna Parking Lot at 7:30 a.m.
Students will be transported by VIRTUS-trained volunteer parents and Saint Susanna Faith Formation Staff to Perfect North Slopes in Lawrenceburg, IN. We will return some time between 7:00-8:00 p.m.
*Please pack a lunch and bring approximately $10 for dinner. We will stop on our way home
*Make sure you dress warmly and in water proof clothing for skiing!
*Bring an extra set of clothes to change into for the ride home & games/books to read and play in the lodge
Name (Printed):______Phone: ______
Address:______City:______ZIP:______Email:______
Allergies and/or medical condition:______
EMERGENCY CONTACT INFORMATION:
1. Name: Phone #: Cell Phone #:
2. Name: Phone #: Cell Phone #:
PARTICIPATION CONSENT:
I grant permission for my child to participate in the Perfect North High School Ski Trip. I will not hold the Archdiocese of Indianapolis or Saint Susanna Catholic Church responsible in the event of any injury or accident to my son or daughter while participating in this event, and/or traveling to and from the Lawrenceburg, IN. I warrant that, to the best of my knowledge, my child is in good health and able to participate in this activity. (Please submit a statement indicating limitations and/or conditions of which we should be aware.)
In case of medical emergency, I understand that every effort will be made to contact parents or guardian of participants. In the event that I cannot be reached, I hereby give permission to the Youth Minister to seek treatment for my son/daughter. I hereby give permission to the medical staff to hospitalize, secure proper treatment for, and to order injection, anesthesia, or surgery for my child.
Parent/GuardianSignature:______Date:______
Name: (Printed)______Phone:______
Youth Signature:______Date:______
Turn in form to Faith Formation Office for Ellice Bedel on or before Friday, December 21 along with $60 check written to St. Susanna
Call or e-mail Ellice Bedel at the Faith Formation Office with any questions or concerns:
838-7723