Life Teen Skateland

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We will NOT meet at the parish. Please meet at USA's Skateland in Chandler.

I am registering*

1 youth 2 youths 3 youths

Teen 1 Name*

First Name

Last Name

Gender

Age*

Teen 2 Name*

First Name

Last Name

Gender*

Age*

Teen 3 Name*

First Name

Last Name

Gender*

Age*

Please list any special needs your child(ren) may have that we should be aware of for this event:*

Parent Name*

First Name

Last Name

Phone*

Email*

If your E-mail is not on the Parish mailing list, would you like to add it?*

Yes No

How did you hear about this event?*

Bulletin Flocknote Personal Invitation Web

Emergency Contact Name*

First Name

Last Name

Emergency Contact Phone*

I request that St. Timothy permit me and my children to attend the Life Teen outing on May 20, 2018 at USA's Skateland in Chandler, AZ. In consideration for my participation, on behalf of myself, my child(ren), and our heirs, assigns, executors and personal representatives, I hereby release, absolve, indemnify and agree to hold harmless St. Timothy Roman Catholic Parish Mesa, the Roman Catholic Church of the Diocese of Phoenix, and any and all of their officers, directors, agents, employees, representatives, volunteers, or sponsors from any and all liability for any and all injury that may arise out of participation in this activity, including any transportation or vehicle related incidents. I also authorize the supervisor of the Life Teen event or his/her designee to seek/provide first aid or similar care in non-emergency situations, and to seek emergency medical assistance when they deem it necessary, for which I will be financially responsible. Further, I give permission to have photos taken of my child(ren) for the purpose of parish use.

I/we agree*

Yes No

Please contact Meagan Martinez at (480) 775-5234.

Parent/Guardian Signature*

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Use your mouse or finger to draw your signature above

Date*

Total Due $