Senior Retreat Permission Form - Our Lady of Good Counsel High ...
Senior Retreat Permission Form - Our Lady of Good Counsel High ...
Senior Retreat Permission Form - Our Lady of Good Counsel High ...
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SENIOR RETREAT PERMISSION SLIPThe parents/guardians <strong>of</strong>____________________________ request that he/she(Child’s Name)participate in the <strong>Senior</strong> <strong>Retreat</strong> in Sparks, Maryland. We understand that transportationto and from the retreat will be by school bus. Students will leave school at 8AM onMonday and will return to the building on Tuesday around 4:30 PM.The dates for this retreat are: (Please circle one)January 28 – 29, 2013 February 25 – 26, 2013 March 11 – 12, 2013I understand that the rules <strong>of</strong> <strong>Our</strong> <strong>Lady</strong> <strong>of</strong> <strong>Good</strong> <strong>Counsel</strong> <strong>High</strong> School as stated in theParent/Student Handbook are in effect at all times during the retreat. As aparent/guardian I agree to:1. Release and discharge <strong>Our</strong> <strong>Lady</strong> <strong>of</strong> <strong>Good</strong> <strong>Counsel</strong> <strong>High</strong> School and its employeesfrom any liability resulting from any claims <strong>of</strong> action for personal injury or medicalexpenses that may arise from school transportation.2. Not hold <strong>Our</strong> <strong>Lady</strong> <strong>of</strong> <strong>Good</strong> <strong>Counsel</strong> <strong>High</strong> School liable for any injurious actionsendured on the part <strong>of</strong> my son or daughter while he/she is on the retreat.3. Pick up my son or daughter at Msgr. O’Dwyer <strong>Retreat</strong> House in Sparks, Maryland ifhe or she a) possesses or uses illegal drugs or alcohol; b) is un-chaperoned in an areadesignated for members <strong>of</strong> the opposite sex; c) crosses York Road without using thepedestrian tunnel; d) trespasses on neighboring property; e) uses a cell phone.__________________________________________________________(Signature <strong>of</strong> parent/guardian) (Date)PLEASE BE SURE TO FILL OUT THE BACK OF THIS FORM AS WELL.NO STUDENT MAY ATTEND RETREAT WITHOUT BOTH SIDES OF THISSHEET BEING FILLED OUT AND SIGNED BY A PARENT/GUARDIAN.RETURN TO STUDENT’S COMMUNITY OR THE CAMPUS MINISTRYOFFICE.