PARENTAL CONSENT FORM & INDEMNITY AGREEMENT - For Day/Field Trips Year Long – St. Mary of the Lake Youth Ministry 2026-2027

The undersigned,(printed parent/guardian name)*, does hereby give permission for our (my) child, ("Participant")*, to attend and participate in youth ministry events and activities scheduled from September 1, 2026 through August 31, 2027, including middle school and high school youth ministry events sponsored by St. Mary of the Lake Catholic Church. These events may require transportation to locations away from the parish/school site and will take place under the guidance and direction of parish employees and/or volunteers. To ensure proper chaperone ratios, transportation arrangements, and necessary permissions, I understand that certain off-site events or ministry activities may require advance registration, RSVP, and/or payment of participation fees.
EARLY RETURN HOME POLICY: Should it be necessary for my child to return home due to medical reasons, disciplinary action or otherwise, the undersigned shall assume all transportation costs and responsibility.
 
TRANSPORTATION PERMISSION: I hereby give permission for my child to ride in any vehicle driven by approved ADULT chaperones while attending and participating in youth ministry events sponsored by St. Mary of the Lake Catholic Church. My child/youth and I understand that SEAT BELTS SHALL BE WORN AT ALL TIMES during transportation and are responsible for compliance.

Walking: I give permission for my child to walk between event locations, including but not limited to walking between St. Mary of the Lake Church and Parish Life Center and local destinations within reasonable distance. I understand that as a participant, my child will remain with the group and/or approved St. Mary of the Lake chaperones.

Meet At Events: I understand that if the event details denote it is a MEET-AT event, I will be responsible for my child's transportation.
To participate in the above-named activity and I warrant that my child is in good health. In consideration of my child’s participation, I agree to indemnify the parish/school and the Archdiocese of Saint Paul and Minneapolis from any claims or lawsuits brought against the parish/school /Archdiocese of Saint Paul and Minneapolis by myself, my child or others, which arises out of any behavior by my child at the event/activity described above. I also agree to pay reasonable attorney fees or expenses incurred by the parish/school and the Archdiocese in defense of such a claim/suit.

Communicable Disease Release, Hold Harmless & Indemnification Agreement: I agree to hold Releasees harmless, release, defend, and indemnify Releasees for any communicable disease claim arising out of the above Event that is brought against Releasees by myself, participant, my family members, heirs, assigns, executors, and personal representatives. I understand and agree this communicable disease release, hold harmless, and indemnification agreement includes claims based on the actions, omissions, or negligence of participant, myself, and others, including, but not limited to the Releasees.
By typing my signature below, I acknowledge and agree this electronic or digital signature is the legally binding equivalent to my handwritten signature. This electronic or digital signature has the same validity and meaning as my handwritten signature. By typing my signature below as guardian, I acknowledge and agree to the conditions above. Electronic Signature
Please type your full name.

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Medical Matters

St. Mary of the Lake will take reasonable care to see that the following information will be held in confidence. This medical authorization and information applies to all covered youth ministry events during the permission period.
I understand that if my child’s medical information changes; I will need to resubmit this form with updated information at a later date. (Please initial).
Emergency Medical Treatment: In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment.
In the event of an emergency, if you are unable to reach me at the above numbers, contact:

First NameLast Name
Relationship
Emergency Contact Cell Phone Number

Area CodePhone Number
Emergency Contact Home Phone Number

Area CodePhone Number
Specific Medical Information

St. Mary of the Lake will take reasonable care to see that the following information will be held in confidence.
Medications: My child is taking medication at present. My child will bring all such medications necessary and such medications will be well labeled. Names of medications and concise directions for seeing that the child takes such medications, including dosage and frequency of dosage, are as follows:
Names of medications and concise directions for seeing that the child takes such medications, including dosage and frequency of dosage, are as follows:
Allergic reactions (medications, foods, plants, insects, etc.):
Immunizations: Date of last tetanus/diphtheria immunization:
Does child have a medically prescribed diet?
You should be aware of these special medical conditions of my child:
Family Doctor/Physician's Name
Family Doctor/Physician's Phone Number

Area CodePhone Number
Family Health Plan Carrier
Policy/Identification/Group Number

Submission Page
As Parent or Guardian, I agree to all of the above stated considerations and conditions.
By typing my signature below, I acknowledge and agree this electronic or digital signature is the legally binding equivalent to my handwritten signature. This electronic or digital signature has the same validity and meaning as my handwritten signature. By typing my signature below as guardian, I acknowledge and agree to the conditions above. Electronic Signature
Please type your full name.

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Please verify that you are human
Should be Empty:

PARENTAL CONSENT FORM & INDEMNITY AGREEMENT For Day/Field Trips -- Year Long – St. Mary of the Lake Youth Ministry

Medical Matters

Submission Page