Middle School Halloween Party All Middle School students are invited to the Middle School Halloween Party! Sunday, October 24 6:00-8:00pm Download the PDF registration form. Register Below Activity InformationDESTINATION: Blessed Sacrament DATE & TIME OF EVENT: Sunday, October 24, 2021, 6-8 pm DESIGNATED SUPERVISOR OF ACTIVITY: Christine Sellnow: 698-6321, Kathy Russell 600-1112 METHOD OF TRANSPORTATION: OwnStudent Information & PermissionStudent Name First Last Student AgeGradeI am a member of Assumption BVM Blessed Sacrament Our Lady of Grace St. Brigid Other I am not a member of Blessed Sacrament, St. Brigid, Assumption, or Our Lady of Grace but my son/daughter is friends with: Parents, would you be interested in chaperoning? Yes No Chaperone Name Permission*I , the parent of the aforementioned student request that Blessed Sacrament Parish, St. Brigid Parish, Our Lady of Grace, and Assumption BVM Parish allow my son/daughter to participate in the activity described above. I give permission for my child to participate in said trip. In consideration for my son’s/daughter’s participation, I hereby release, save harmless and indemnify Blessed Sacrament Parish, St. Brigid Parish, Assumption BVM Parish, and Our Lady of Grace, its employees, volunteers, agents and any sponsors or benefactors of said trip from any and all liability from any and all injury. I understand that my son/daughter will be under the supervision of the designated supervisor and chaperones on the stated dates and that all parish rules will be in effect. I understand and agree that, if my son/daughter violates a parish rule, he/she will be sent home. I agree.Medical InformationMedical Consent*In case medical treatment is necessary and the parents or guardian cannot be located, the following authorization is needed, I (We) authorize the adult advisor in charge to consent to any neces¬sary examination, anesthetic, medical diagnosis, surgery or treatment, and/or hospital care to be rendered to the above named minor under the general or special supervision and on the advice of any physician or surgeon licensed to practice medicine in the state of Michigan. I agree..Allergies:Chronic diseases or medical problems:Medicines son/daughter is now taking:Medicines that need to be dispensed during this activity must be given to the designated supervisor in its original container with directions and dosage.Medical Insurance Carrier:* Policy/Contract Number:* Family Physician:* Physician Phone:* Parent (Gaurdian) Name:* Parent (Gaurdian) Signature*Contact InformationAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home Phone:Work Phone:Cell Phone:Emergency Contact Name:* Emergency Contact Phone:*Family Email Parish Event Participant Agreement:Coupling swearing, smoking, drinking, gambling, possession of alcohol, drugs, or firearms are NOT permitted at our church youth functions. Any youth found in violation of these rules will have their parents called and will be sent home.Teen Signature*Date MM slash DD slash YYYY Teen Cell Number (if applicable):CAPTCHAEmailThis field is for validation purposes and should be left unchanged.