DATE & TIME OF EVENT: Saturday, April 22, 2023: 9:00am - Sunday, April 23, 2023: 4:00pm at Camp Rotary
DESTINATION: Camp Rotary; 3201 S. Clare Ave; Clare, MI Phone: 989-386-7943
DESIGNATED SUPERVISOR OF ACTIVITY: Justin Rose (989.941.8460) Kathy Russell (989.600.1112) Camp Rotary (989.386.7943)
CHAPERONES: Dave Pasek, Wendy Shields, Kim White, Renee Urlaub, Derek Haddad, Justin Rose, Kathy Russell, Kristyn Russell, Justin Dean, Callie Losinski
METHOD OF TRANSPORTATION: Carpool
(Please note: The minimum acceptable liability limits for a privately owned vehicle is $500,000 CSL [Combined Single Limit] or an Umbrella Policy. Drivers must fill out a Volunteer Driver Information Sheet located in the Faith Formation Office and have both sides of your drivers license copied.)
Adult Chaperones: If you can spare some time to help keep our kids safe during our time together, please mark "yes" on this form or call Justin Rose.
I , the parent of the aforementioned student request that Blessed Sacrament Parish and Assumption of the Blessed Virgin Mary 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 and Assumption of the Blessed Virgin Mary Parish, 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 chaperons on the stated dates and that all parish rules listed below will be in effect. I understand and agree that, if my son/daughter violates a parish rule, he/she will be sent home.
Medicines that need to be dispensed during this activity must be given to the designated supervisor in its original container with directions and dosage.