Author: carriep

WEDNESday, June 13 * 8:30am-8:00pm * St. Mary’s Parking Lot *

ValleyFair 2018

Please bring:
Spending $ for 2 meals at ValleyFair or bag lunch
Swimsuit, towel, and quarters for lockers for the water park
Sun block
Please leave at home:
Valuables
Weapons
Drugs/Alcohol/ Tobacco

This year Calvary is offering the trip for youth who have completed Gr. 6-12
Any youth going into sixth grade and under must have a parent or adult accompanying them.

Name________________________________________ Grade______
Church_____________________________________
Parent or Guardian _________________________________Phone___________________
Parent Email: ___________________________________________
Alternate person to contact in case of emergency:
Name______________________________________Phone__________________________
Name______________________________________Phone_________________________
Please list any medications or health concerns.
_________________________________________________________________________
The undersigned does hereby give permission for our (my) child,_____________________________________
To participate in the Joint Valley Fair Trip with Calvary on June 13, 2018
We (I) authorize an adult, in whose care the minor has been entrusted, to consent to any X-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment, and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital.
The undersigned shall be liable and agrees to pay all costs and expenses incurred in connections with such medical and dental services rendered to the aforementioned child pursuant to this authorization.
Parent or Guardian________________________________________ Date____________
Insurance Information______________________________________________________

This event includes youth from area Catholic and Lutheran
churches and friends!

Only
$35!

This form and $35 is due NO LATER than May 31. Please turn it in to Ashley.
Please make checks payable to Calvary Lutheran Church.
(Calvary, Vinje, Bethel, or St. Mary’s)