Saturday March 3rd
From
6 – 8 pm at SCS gym
Mother & Son Floor
Hockey* Game!
Please submit form and check no later than
Feb 17th
Pizza & Ice cream will be served
Cost: $20 for first boy/son, $15 for each thereafter
* Floor hockey sticks will be available for use or bring your own
Please complete and return with
check made payable to: SCS/Floor Hockey by Feb 26th.
If you
miss the deadline, price will be $25 per child in family. For more information email Pam Willis @ mom2edw@yahoo.com or Alison Sullivan @ Dollfin72@aol.com
Consent and Release
I, the undersigned, as legal adult and parent of, or legal guardian
(“Myself” or “I”)) of a minor child (“My Child”) do hereby consent to My Child’s
participating in the voluntary Mother/Son Floor Hockey program with St Catherine of Siena (SCS) school. I also agree
to forever release SCS, and all their officers, boards, committees, employees, agents, or volunteers (the “Releases”)
from any and all liability, claims, rights of action and causes of action that may arise from personal injuries to Myself
and/or My Child or any real or personal property damage resulting from My Child’s participation in the SCS voluntary
Mother/Son Floor Hockey program. I affirm that I have read this Consent and Release statement and I understand
the contents. I understand that this is a legal document and that by signing it I may be giving up substantial legal rights
for Myself or My Child and acknowledging that I am giving up any right to sue or to otherwise make a claim against Releases
on behalf of myself or on behalf of My Child. I further understand that my child’s participation
in this program is voluntary and I consent to this participation on behalf of My Child. By signing this form, I affirm that
I have agreed to allow My child to participate in this program with full knowledge that the Releases will not be liable to
anyone for personal injuries and/or property damage that myself or My Child may cause, in whole or in part, or sustain in
connection with the Mother/Son Floor Hockey program described herein.
Medical release: I herby give permission to the Releases to provide
and administer immediate first aid and authorize a physician at a local hospital to secure proper treatment for Myself and/or
My Child as necessary.
Media Release:
I agree that pictures taken of Myself or My Child in connection with the program may be used for promotional purposes and
that Releases are not liable for any unforeseen or unintended use of such pictures by third parties.
Guardian’s name:_____________________ Date ______
Son/student’s name:______________________
Grade_______
Son/student’s name:______________________ Grade_______
