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St. Andrew Dinner Parent Consent Form

"Leading our brothers to the Lord"

St. Elizabeth Seton Catholic Church
10655 Haverstick Rd.
Carmel, IN 46033

November 19, 2020
7:00pm to 9:15pm
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- Participant Name REQUIRED Please fill out this field. Please enter valid data.
- Parish/School REQUIRED Please fill out this field. Please enter valid data.
- Grade REQUIRED Please fill out this field.
- Participant Email (optional) Please enter an email address.
- Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Parent/Guardian Email REQUIRED Please fill out this field. Please enter an email address.
- As 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 the Diocese of Lafayette-in-Indiana, its officers, directors, employees and agents, chaperones, or representatives associated with the event, from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the Diocese of Lafayette-in-Indiana, its officers, directors, its employees and agents, chaperones, or representatives associated with the 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 Diocese of Lafayette-in-Indiana.
- Please answer according to the liability statement above: REQUIRED Yes No Please fill out this field.
- Registration Form Consent - Parent/Guardian First & Last Name REQUIRED
  I, as parent/guardian of my son, hereby give consent to all of the information provided in the above consent form.
  Please fill out this field. Please enter valid data.
- Date REQUIRED Please fill out this field. Please enter valid data.
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610 Lingle Ave. Lafayette IN 47901 (765) 742-0275	The ministries of our diocese and this website are made possible through the generosity of the Fruitful Harvest donors. Thank you!

St. Andrew Dinner Parent Consent Form

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