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- Faith Formation

Cedar Point fees may be paid online at:
- https://www.osvhub.com/stmarkgoodrich/funds
Dear Parent or Legal Guardian,
Your son/daughter is eligible to participate in a parish-sponsored activity requiring transportation to a location away from St. Mark the Evangelist and Holy Family premises. This activity will take place under the guidance and supervision of staff/volunteers from St. Mark the Evangelist and Holy Family Catholic Church.
Name of Event: Cedar Point Trip
Destination: Sandusky Ohio - Cedar Point Amusement Park
Designated Supervisor of Activity: Deacon Ron Kenney, Director of Faith Formation St. Mark, and other Adult volunteers from St. Mark
Date and Time of Departure: Wednesday, June 29, 2022 6:00am St. Mark Parking lot
Date and Time of Return: Wednesday, June 29, 2022 11:59pm St. Mark Parking lot
Method of Transportation: Motor Coach Bus (Route 23)
Student Cost: $90.00 (Includes Cedar Point Admission and Bus Transportation and all-you-can-drink wristband in the park)
Emergency Phone: 810-845-8379 (Deacon Ron's cell)
If you would like your child to participate in this event, please complete the following statement of consent and release of liability by filling out the form below. As parent or legal guardian, you remain fully responsible for the actions and conduct of your child.
The maximum number of form submissions has been reached. This form is currently not available.
- Parent's First & Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date REQUIRED Please fill out this field. Please enter a date.
- Child's First & Last Name REQUIRED Please fill out this field. Please enter valid data.
- HOME Phone Number Maximum 20 characters Please enter a phone number.
- WORK Phone Number Maximum 20 characters Please enter a phone number.
- CELL Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- CHILD'S ADDRESS REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Email REQUIRED Please fill out this field. Please enter an email address.
- STATEMENT OF CONSENT: I hereby consent to participation by my child in the event described above. I understand that this event will take place away from the parish grounds and that my child wil be under the supervision of the designated parish staff/volunteers on the stated dates. I further consent to the conditions stated above on the participation in the event, including the method of transportation. I also agree to allow appropriate photographs and videos of my child on this event to be used by St. Mark the Evangelist and Holy Family Catholic Church for information and promotional purposes only. In consideration of my child being allowed to participate in this field trip, I agree to indemnify and hold harmless St. Mark the Evangelist and Holy Family Catholic Church, and and all affiliated organizations, their employees, agents, and representatives, including volunteer and other drivers, from any and all claims including negligence, arising from or relating to my child's participation in this field trip. This indemnification and hold harmless agreement does not apply to claims for intentional misconduct or gross negligence.
  I Agree Please select this field.
- HEALTH PERMISSION FORM: I grant permission for non-prescriptive medication (e.g. Tylenol, throat lozenges, cough syrup, pepto-bismal) and routine nonsurgical medical care to be given to my child if deemed advisable by the supervising parish personnel. In case of an emergency, I also grant permission to transport my child to the nearest hospital for emergency medical or surgical treatent. I will be contacted as soon as possible and will be advised prior to any further treatment by the hospital or doctor. In the event it is impossible to contact, I consent and authorize St. Mark the Evangelist and Holy Family Catholic Church, and its agents to consent to any necessary steps that will secure my child's health and safety under the advice of a licensed physician/surgeon (examination, anesthesia, diagnosis, treatment, surgery, and hospital care are included) as governed by the laws of the State where medical treatmnet is being sought. I understand that I am responsible for any and all costs incurred by the above actions being conducted.
  I Agree Please select this field.
- My child is allergic to: Please enter valid data.
- My child must take the following medication (include dosage, frequency, etc.) Please enter valid data.
- Please note specific medical problems: Please enter valid data.
- In case of an emergency notify: REQUIRED Please fill out this field. Please enter valid data.
- Emergency Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Family Health Plan Please enter valid data.
- Family Health Plan Number Please enter valid data.
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St Mark Evangelist Catholic Community

7296 Gale Road Grand Blanc, , MI
810-636-2216

7296 Gale Road
Goodrich/Grand Blanc, MI

Cedar Point fees may be paid online at:

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