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Burlington Life Teen
Information on the Red Eye Late Night Extravaganza
When: Friday, February 6, 2009
Cost: $25.00.
Cost Includes: Transportation, Movie Ticket @ Palace 9, Pizza & Galactic Bowling
at Spare Time,
formerly known as Yankee Lane (What the heck?!)
Transportation: Mountain Transit Bus (If you REALLY want to, you can sing cheesy bus songs…)
Drop off 6:15 PM at Christ the King, So. Burlington
Pick up: 2:00 AM at Christ the King, So. Burlington
Permission slip must be completed and returned with a $25 check made payable to
Burlington Life Teen
Mail to:
Burlington Life Teen
Att: Monica Morano
20 Allen Street
Burlington, Vermont 05401
Or
Drop in collection baskets at
Christ the King/St. Anthony, St. Mark’s or St. Joseph Co-Cathedral in an envelope clearly marked Burlington Life Teen Att; Monica Morano
Deadline: Monday, February 2, 2009
First 40 permission forms with $25 will be accepted.
For more information please feel free to e-mail Monica Morano at burlingtonlifeteen@gmail.com
Or call (802)878-6861
Teens will be expected to stay with the group for the whole evening. No early pick up or late arrivals will be allowed. Any teen leaving any part of the event will not be allowed to return to the activity and parents will be called.
Permission Slips maybe found at:
Rice:
http://ricehs.org/riceweb/ricehs_interim.asp
Christ The King web site @
http://www.ctkstabtv.com/main/index.php
Burlington Life Teen web site @
http://burlingtonlifeteen.wordpress.com
FORM: (copy and paste into word, and print)
REGISTRATION FORM FOR SPECIAL ACTIVITIES AND FIELD TRIPS
DIOCESE OF BURLINGTON
______________________________________________________________
Parish or Sponsoring Group: Burlington Life Teen
Activity: Red Eye Late Night Extravaganza Friday, February 6, 2009
Destination: Palace 9 Movie Theater & Spare Time for Galactic Bowling (information sheet attached)
Supervising Adult: Name & # Monica Morano 878-6861 or 233-9647
Mode of Transportation: Mountain Transit Bus
Drop off @ Christ the King School 6:15 PM
Pick up @ Christ the King School 2:00 AM
======================================================================
Student’s Name: __________________________________________Age/Grade: _____________
Parent(s)/Guardian: ________________________________________Phone: ________________
Address: __________________________________City/State/Zip: ________________________
Emergency Contact: _______________________________________ Phone: ________________
Health Insurance Company: ________________________________________________________
Health Insurance Policy Number: ___________________________________________________
Any Special Medical Needs that We Should Be Aware of: ________________________________
Is the participant currently under a doctor, psychologist or psychiatrists care? _________________
If so, please explain: ______________________________________________________________
======================================================================
Parent/Guardian—Please read carefully:
I request that my son/daughter participate in the above-described activity and consent to the mode of transportation as indicated.
Should emergency medical treatment be necessary and I am unable to be contacted immediately, I authorize the delegated agents of the above-mentioned organization to act on my behalf and approve appropriate treatment.
I specifically waive claim or claims that may be derived from any accident or injury sustained by my son/daughter en route, during, and returning from the activity. I further agree to indemnify and save harmless the above name parish/school, the Diocese of Burlington, their staff and all adult supervisors working on their behalf.
Parent/Guardian Signature: ___________________________________________Date: _____________________________________
Participant Expectations:
I have read the Participant Expectations for this event as set forth on the information sheet and understand what is fully expected of me. I agree to follow these expectations at all times during the event.
Signature of Teen Participant Date
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