STUDENT OUTING FORM

Name: _______________________________________ Class: ____________ Age: ________________ Address: ______________________________________________________Phone: ________________ I/We, the parent(s) of the above named student, hereby request that our child be permitted to attend the outing to _________________________________________________________ on ________________ I/We hereby release, absolve, indemnify and hold harmless St. Francis Xavier Parish and School, and the Diocese of Burlington, and all their volunteers, representative, employees and agents for any and all claims, causes of action, or liability of any nature arising from this activity or outing. My child and I understand that all field trips are an extension of the school program and, as such the participants are subject to all rules of conduct expected of a St. Francis Xavier School student. Parent Signature ________________________________ Parent Signature ________________________________ Emergency Contact # ____________________________

All students will be transported by bus to Outing Events.

5 St. Peter Street, Winooski, VT 05468-1316 ~ (802)655-2600 ~ FAX: (802)655-3096 ~ www.sfxvt.org