ARCHBISHOP COLEMAN F.

CARROLL HIGH SCHOOL

PARENT/GUARDIAN PERMISSION AND RELEASE FORM

For Athletic Participation, Off-Campus Activities & Fieldtrips

•.:. IIWelParentslGuardians request that Archbishop Coleman F. Carroll High School allow my/crur child

to participate in the following activityltrip/event as indicated below and that JJwe hereby
release and hold harmless from liability any volunteers and the school employees involved, inducting administrators
and supervisors.

Student's Name: --------:--c--------:-::-:::-----:::---------

(please Print) First Middle Last

ActivityrrriplEvent ~T. John Neumann Cornivo.\

LocationIDestination St.Jcrw) NeuMann CcxthoHc, C\jl.)(ch (\'Z.\~ SW lo1t"l AVe.)

(10:30 call 'time)
Date 02./OlP/IO Departure \ \:OOaM Anival._4:...:...:0:...Q=-..J:P_M~ _

~eaDsofTransporlation~B~e=s~t~vJ~O=ir-B~u~S~---------- _

Supervision TUSTIn t-\oLlSe

Cost $ _...<:P==-- __ Each Student should brlng: _

Other comments or instructions:

------------------~-----

• CONTACT PERSON IN CASE PARENT CANNOT BE REACHED:

Name: _______________ Phone:
,-
• J/W e understand that adult supervision will be provided ~d.,mat appropriate care will be taken for the health and safety
of ail the students. '
IfW e understand that IIW e will be responsible and see that transportation is provided for my/our clnld should it become
necessary for the school authorities to send my/our child home because of disciplinary actions or for any other reason.
IfWe understand that the school authorities will contact us as necessary.
IIWe understand that school authorities will take action on my/our child per instructions on the school emergency card
should it become necessary to do so. Our health insurance company card information is as follows:

(Print) Health Insurance Company Agreement Number

Date: Signature of Parenti Guardian: _

--------
Contact
Telephone
Number(s) for Parent _

10300 SOUTHWEST f 6T'" AVENUE

MIAMl, FLORIDA 33196
TEL..;305.366.0700
FAX 305.388_4371
EMAIL: COL5:MANCARROLL@COLE:MA.NCARROLLORG