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Indiana Dunes Outing Saturday, September 20, 2008, 9:00am-5:00pm Indiana Dunes State Park, Porter County, Indiana Enjoy a day of fun in the sun! Open to 8th graders and high school students Due to space limitations, there is a 20 student maximum. FREE! We will provide food, transportation, and activities. All students must have their parents sign the authorization form to attend. Board the St. Therese school bus in the parking lot at 9:00am. We will return to the school lot around 5:00pm. For more information, contact: Fr. Michael (312) 842-6777 Joe A. Delfin (312) 925-4240 Or email

Youth Permission & Parental/Guardian Authorization I hereby give permission for my son/daughter ________________________________(name) to participate in the INDIANA DUNES OUTING to be held on SATURDAY, SEPTEMBER 20, 2008 from 9:00AM-5:00pm at INDIANA DUNES STATE PARK in Porter County, Indiana. I understand that if my teen will be driven to and from the event by an adult driver and that driver will have submitted to a background check and have participated in the Archdiocese of Chicago Virtus Training Program. I also understand that all adult leaders from the parish/school/Deanery/Vicariate will be in compliant with the guidelines from the Archdiocese of Chicago in regards to VIRTUS TRAINING. I HEREBY RELEASE AND INDEMNIFY THE CATHOLIC BISHOP OF CHICAGO, A CORPORATION SOLE, THE ARCHDIOCESAN OFFICE FOR CATECHESIS AND YOUTH MINISTRY, its staff and volunteers; AND ST. THERESE CHINESE CATHOLIC CHURCH & SCHOOL, its staff and volunteers, from any and all liability arising from claims of any kind or nature whatsoever from my teen's participation in this event. I UNDERSTAND that if my son/daughter violates any laws regarding possession of alcohol or drugs, or rules governing the event, arrangements will be made to immediately send my teen home at the cost of the parents/guardian. IN THE EVENT THAT THE UNDERSIGNED CANNOT BE REACHED AND IN THE JUDGMENT OF THE RESPONSIBLE ADULT AT THIS EVENT or other staff member, there is a necessity for immediate examination and/or treatment of my teen, I HEREBY AUTHORIZE ANY OF THE AFORESAID PERSONNEL TO OBTAIN FOR MY TEEN, SUCH MEDICAL SERVICES AS ARE DEEMED NECESSARY. ***I GRANT PERMISSION for the adult chaperons for this event to administer nonprescription drugs as needed for my teen (i.e., aspirin, ibuprofen, antacids, etc.) YES___________ NO____________ ***I AUTHORIZE St. Therese Chinese Catholic Church & School to use photographs/videos of my teen for productions, publications, etc. _________ YES _________NO______________ PARENT/GUARDIAN SIGNATURE:________________________________________________________________ TELEPHONE #(H)____________________________(Cell #)_________________________ EMERGENCY TELEPHONE # ________________________________________________ CONTACT___________________________________________________________________ RELATIONSHIP:_____________________________________________________________ __ ****PLEASE LIST any ALLERGIES, MEDICATIONS, MEDICAL PROBLEMS: PHYSICAL ACTIVITIES/LIMITATIONS that your teen CANNOT take part in.

Indiana Dunes Permission Form  

This is the parental permission and authorization form for the Indiana Dunes Outing.