St. Joseph Catholic Parish

4521 Arden Road, Otis Orchards, WA 99027
Phone: 509-926-7133

Monday - Thursday | 8:30am - 4:30pm
Friday | 8:30am - 1:30pm

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Youth Permission Slip

- Growing in Faith
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    Youth Permission Slip
Youth Permission Slip
- Youth Permission | Altitude Trampoline Park - 10/4/26
- Youth Permission | General

Altitude Trampoline Park Permission Slip | 10/4/26
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- DIOCESE OF SPOKANE
  PARENTAL PERMISION SLIP
  AND LIABILITY REALEASE FORM
  
  EVENT: St. Joseph Youth Events and Service Opportunities
  LOCATION: Altitude Trampoline Park
  DATE OF EVENT: October 4, 2026
  PARISH SPONSORING EVENT: St. Joseph Parish - Otis Orchards
  INDIVIDUAL(S) IN CHARGE OF AND RESPONSIBLE FOR EVENT: St. Joseph Youth Team
  MODE OF TRANSPORTATION TO BE USED:
  Cars driven by parent volunteers: _____ Private vehicles meet at venue: ____X____
  MEET AT ST. JOE'S
  COST:
- CHILD'S NAME REQUIRED Please fill out this field. Please enter valid data.
- The undersigned parent(s)/legal guardian give permission for our (my) child to attend and participate in the above described event.
  
  We (I) understand that this event will take place at a location away from the parish grounds, that the above-described mode of transportation to and from the location will be used, and that our (my) child will be under the supervision of the above-designated individual(s).
  
  In case of a medical or dental emergency, we (I) give our (my) consent and authorization for any necessary treatment, to include treatment by a licensed physician or dentist and transfer to any hospital reasonably accessible.
  I Agree Please select this field.
- The following information is provided for any licensed physician, dentist, or hospital not having access to our (my) child's medical history:
- MEDICAL INSURANCE COMPANY REQUIRED Please fill out this field. Please enter valid data.
- POLICY NO. REQUIRED Please fill out this field. Please enter valid data.
- FAMILY PHYSICIAN REQUIRED Please fill out this field. Please enter valid data.
- PHYSICIAN PHONE NUMBER REQUIRED
  
  Please fill out this field. Please enter a phone number.
- DATE OF LAST TETANUS SHOT REQUIRED Please fill out this field. Please enter valid data.
- ALLERGIES
- MEDICATION BEING TAKEN REQUIRED Please fill out this field.
- OTHER PERTINENT INFORMATION
- In case of an emergency, we (I) can be reached by phone at:
- HOME REQUIRED
  
  Please fill out this field. Please enter a phone number.
- WORK
  
  Please enter a phone number.
- OTHER
  
  Please enter a phone number.
- We (I) shall be liable for and agree to pay all costs and expenses incurred in connection with any medical or dental treatment rendered pursuant to this authorization. Further, should it be necessary for our (my) child to return home due to medical reasons, disciplinary action or otherwise, we (I) shall agree to pay transportation costs.
  
  We (I) release, discharge and agree to hold harmless the Catholic Bishop of Spokane, his agents and employees from any and all liability, claim to demands for personal injury, illness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by us and/or my child while our (my) child is participating in the event (including transportation to and from the event). Hereby assuming all risk of personal injury, illness, death, damage and expense as result of participation in this event.
  
  Parents/Guardians of participants are advised that photographs and videotape of the participants may be used in publication, websites or other materials periodically produced by the Diocese of Spokane. (Participants would not be identified, however, without specific written consent.) Please note that the Office has no control over the use of photographs or film taken by the media that may be covering the event in which your child(ren) participate(s).
  We (I) have fully read this form and sign it voluntarily with knowledge of its terms and conditions. Please select this field.
- SIGNATURE REQUIRED Please fill out this field. Please enter valid data.
- DATE REQUIRED Please fill out this field. Please enter a date.
- RELATIONSHIP REQUIRED Please fill out this field.
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