Community Celebration at Disneyland on Rosary Day

  • Please complete and return this form and the Behavioral Contract to the Activities Office by Friday, 09/08/2017.
  • If your daughter is not attending Disneyland, you MUST submit an Opt-out form by Friday, 09/08/2017.

Student Name:______DOB: ______Age: _____ Grade:_____

Yes, I plan to go to Disneyland after the Rosary Day ceremony on 10/06/2017. Check One:

___ I would like to order a Disneyland ticket for $95.00.

I am attaching the $95.00 with payment in the form of: ___Cash; ___Check #:______

___ I will not be purchasing a ticket through Rosary Academy.

Parent Permission:

I the undersigned, give my permission for my daughter to join the community celebration at Disneyland on Friday, October 6, 2017, following the conclusion of the Rosary Day Mass and celebration on campus. I understand that Rosary Day will end at 11:00 a.m. and all students must leave campus by 11:30 a.m. Further, I understand that it is my responsibility to provide transportation to and from Disneyland. Rosary Academy will not provide ANY transportation to or from Disneyland.

Should it be necessary for my daughter to have medical and/or dental treatment while participating in this activity, I hereby give permission to the adult(s) in charge to use best judgment in obtaining medical services. I give permission to the physician selected to render medical treatment deemed necessary and appropriate by the physician.

I agree to release, indemnify, defend and hold harmless Rosary Academy, the Diocese of Orange, and each of their respective employees, directors, officers, agents and the representatives from any and all liability arising from participation in this activity, including but not limited to any lawsuits, claims, or causes of action brought by you or any third party alleging any injuries or damages of any kind, whether relating to personal injury, damage to property, remedies in equity, attorneys’ fees or court costs.

I have read and agree to abide by the conditions of this contract and will follow the Rosary Academy code of Christian conduct.

Parent/Guardian Signature:

Student Signature:

Home Address: City:Zip:

Phone–Home: Phone–Cell: Phone–Work:

Parent/Guardian Email Address: ______

If there is an emergency and parents cannot be reached, please contact:

Name: Relation (Non-Parent)Phone:

Name of Physician: Phone #:

Insurance Company: Policy #:

Special Medications or Medical Conditions:

Allergies to any Drugs or Foods:

8/2017

Behavioral Contract: Diocese of Orange, Rosary Academy

Program:Rosary Day

Location:Disneyland

Date:Friday, October 6, 2017

Time:Rosary chaperones will only be present from 12:00pm – 5:00 pm.

The park closes at 7:00pm.

I, , agree to follow all rules and directions at the event listed above.

PRINT STUDENT NAME

(Student, please initial upon reading each item)

I agree to have a fun and respectful attitude during my time at Disneyland.

I agree to adhere to the Disneyland Resort dress code, prohibited items list and all resort rules and regulations.

I agree to follow all rules and directions of the chaperones.

I agree not to bring or use cigarettes, chewing tobacco, lighters, matches, or alcohol.

I agree to respect the other participants that will be attending this event.

I agree to not use profane language.

I agree to cooperate with all directions and instructions given by Rosary Academy personnel.

I understand and agree to these rules and guidelines. I understand that if Rosary Academy determines my behavior warrants being asked to leave the event, I will be sent home immediately, and my parents will be held responsible for my transportation and financially responsible for any damages that I have caused.

Student Signature:Date ______

Parent/Guardian Signature:

8/2017