EXCEL 2019 Registration Form - CHECK OR SCHOLARSHIP

2019 Excel

NAME OF EVENT

EXCEL 2019

Camp Don Bosco

Time: May 03, 2019 7pm - May 05, 2019, 1:00 pm
Registration
Cost: $115.00
Deadline: 04/12/19
EVENT DETAILS Meet at MQP: 7pm Pick up at MQP: 1:00pm Please submit this form with the $115 fee by April 17th (wait list MIGHT start sooner) Scholarships Available - Contact Cathleen or Colin for information Colin Lewis: colinl@hfkparish.org - 425-822-0295 x108 Cathleen Ito: cathleeni@hfkparish.org - 425-288-0295 x107
Teen's Name
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Grade
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T-Shirt Size
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Teen's E-mail
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Teen's Cell Phone --
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Address
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Parent's or Legal Guardians Names
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Parent's E-mail
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Parent Phone --
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Parent Phone --
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Emergency Contact
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IN CASE WE CANNOT REACH THE PARENTS
Emergency Contact Phone Number --
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I, the parent or legal guardian of the child named on this form, give my permission for the above named child to participate in this event that may require transportation away from the parish site. This event will take place under the guidance and direction of parish employees and/or volunteers from Holy Family Kirkland on 5/3/19-05/5/19. As a parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor ("participant"). I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns to hold harmless and defend Holy Family Kirkland, its officers, directors, employees and agents and the Archdiocese of Seattle, its employees and agents, chaperones or representatives associated with this event, and I agree to compensate the parish, its officers, directors and agents and the Archdiocese of Seattle from any claim arising from or in connection with my child attending the event or in association with any illness or injury (including death) or cost of medical treatment in connection there within, and I agree to compensate the parish, its officers, directors and agents and the Archdiocese of Seattle, its employees and agents, chaperones or representatives associated with this event for reasonable attorney's fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the parish/diocese.
I agree with the above
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Medical Release
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If no, please fill out the online form on our website. If yes, you only need to redo it if any of the information has changed.
Phone --
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PAYMENT OPTIONS
Contact the office for payment options Please contact Cathleen with any questions or for more information on payment options. Checks can made out to and Holy Family and can be dropped off or mailed to the parish office. (Holy Family Kirkland: 7045 120th AVE NE, Kirkland, WA 98033) To set up a payment plan, or to use scholarship funds, please contact Cathleen directly: Cathleeni@hfkparish.org
 
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