Saint Ambrose Religious Education
April 13th ABLAZE Lock-In Permission Form
I, ___________________________________ am the _________________________
(Name of Parent/Guardian)
(Father, Mother, Custodial Parent, Legal Guardian)
of _______________________________, a Jr. High teen at St. Ambrose Catholic
(Teen’s Name)
Church in Brunswick, OH. I hereby grant permission for the above named teen to
attend the Lock-In at the Brunswick Rec Center on Saturday April 13th from 6-9pm and
I consent to the teen’s participation in said event.
PERMISSION FORMS MUST BE TURNED IN TO THE SCHOOL BY APRIL 10TH
I understand that I am to provide transportation to and from the event.
In consideration of my teen being allowed to participate in the Lock-In, on behalf of
my teen, my spouse and myself, I hereby assume all risks in connection with the event
and I further release, discharge, and/or otherwise indemnify the Diocese of Cleveland,
the Bishop of the Roman Catholic Diocese of Cleveland, St. Ambrose Parish, employees
and volunteers from all claims, judgments, liability by or on behalf of my teen, myself
and my spouse for any injury or damage due to the teen’s participation in the Lock-In
including all risks connected therewith whether foreseen or unforeseen. Furthermore,
I acknowledge that it is my responsibility to provide adequate health insurance for my
teen.
There is no cost associated with this is event. The swimming pool, basketball and
volleyball area in the gym will all be available for our youth to enjoy.
Please indicate if you as a parent are able to help chaperone.
I fully understand what is involved in the Lock-In and I understand that I have the
opportunity to email Janet Jancewicz at jjancewicz@saintambroseschool.us or call
Regina Kaletta, Youth Ministry Assistant and 440-823-6190 or 330-460-7334.
_________________________________________
(Parent/Guardian Signature)
____________________
(Date)