Junior High Lock-In Scholarship/pay by cash form

2019

NAME OF EVENT
Thank you for your interest, but the deadline to register for this event has passed and we are no longer accepting registrations.
Thank you for your interest, but the deadline to register for this event has passed and we are no longer accepting registrations.

Jr. High Lock-In

Holy Family Kirkland: Teen Center

Time: February 15, 2019 9:00 pm - February 16, 2019, 8:00 am
Registration
Cost: $20.00
Deadline: 02/15/19
EVENT DETAILS Meet at the Teen Center: 9pm Pick up at the Teen Center: 8am Please submit this form with the $20 fee by 2/10 Scholarships Available - Contact CATHLEEN for information Cathleen Ito - cathleeni@hfkparish.org - 425-822-0295x107
Teen's Name
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Grade
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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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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 October 20 - 21, 2017. 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.
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