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LASER TAG

(St. Augustine Parish, Barberton)


WEDNESDAY, June 19, 2019

This form is due in no later than Friday, June 14.


We will be heading to Laser Quest in Akron to do 2 games of laser tag. We will meet at Laser Quest, 80 Brookmont Rd.,
Akron, at 6:45 and be finished at 8:00. Kids should be dropped off and picked up from Laser Quest.

Cost is $13 (plus tax) a person, if we get at least 10 people, and $8.50 per game if we have under. Money will be paid
individually to Laser Quest, please DO NOT send in a check with the permission form.

What to Bring:
You’re A-game.

Please KEEP the top section as your reminder!!

Please return this section and parent signature by Wednesday, June 19 to Miss Jackie.

I, ________________________________, am the ________________________________ of


(Name of Parent/Guardian) (Father, Mother, etc…)

_______________________________, a participant in Laser Tag.


(Student’s name)
I hereby request permission for the above named child/children to attend the St. Augustine trip to paintballing and I consent to the child’s
participation in this retreat. I understand that I must provide transportation to and from the Church for my child. I hereby assume all risks in
connection with the youth event and I further release discharge, and/or otherwise indemnity the Diocese of Cleveland, the Bishop of the Roman
Catholic Diocese of Cleveland, St. Augustine, employees and volunteers from all claims, judgments, liability by or on behalf of my child, my self and
my spouse for any injury or damage due to the child’s participation in the youth event including all risks connected therewith whether foreseen or
unforeseen. Furthermore, I acknowledge that it is my responsibility to provide adequate health insurance for my child/children. I understand I have
the opportunity to call Jaclyn Snyder at 330-745-1080 and ask her about the youth event.

Child’s Name _____________________________ M/F? Age ____ School _______________

Address__________________________________ City __________________

Parent’s Cell/Emergency#__________________ Parent’s E-Mail_____________________________

Signature of Parent/Guardian_________________________________________

Allergies _____________________________________________________________________

Please list any health problems you may have and any medications being taken at the present time. (Confidential)
____________________________________________________________________________

YES/NO I give permission to St. Augustine, her staff, and her volunteers to use photos from this event of
my child(ren) for the website, facebook page, or any other social media as deemed appropriate.

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