BISHOP KEARNEY HIGH SCHOOL

Reunion Permission Form

Please allow my daughter, _______________________,permission to volunteer at the Bishop Kearney Reunion, which will take place on

_____Friday, April 12, 2019 at The Montauk Club, located at 25 Eighth Avenue, Brooklyn, NY. Arrival time is 4:45 pm.

               ____ I will pick my daughter up from The Montauk Club at 7:30 pm.

               ____ I allow my daughter to travel home unaccompanied from The Montauk Club.

_____Saturday, April 13, 2019 at Bishop Kearney High School, 10:00 am to 3:00 pm.

               ____ I allow my daughter to travel home unaccompanied from Bishop Kearney High School.

Students are required to wear their complete uniform. Students will receive community service hours for their volunteer service.

Completed Permission Slips are Due to the Development Office.

I UNDERSTAND THAT ANY STUDENT VIOLATING THE REGULATIONS FOR THIS EVENT WILL FACE DISCIPLINARY ACTION DETERMINED BY THE SCHOOL. I RELIEVE THE SCHOOL AND ITS APPOINTED CHAPERONES OF RESPONSIBILITY FOR ANY ACCIDENT OR INJURY THAT MIGHT BE INCURRED DURING THIS EVENT.

 

Parent/Guardian Signature_____________________________________

Address___________________________________________________

Home Phone Number_________________________________________

Cell Phone Number___________________________________________

Please indicate here any medical condition chaperones should be aware of

__________________________________________________________

TYPE OF MEDICATION (IF NEEDED) _______________________________

IN CASE OF EMERGENCY CONTACT _______________________________

RELATION TO STUDENT ________________________________________

TELEPHONE NUMBER__________________________________________

STUDENT’S CELL PHONE NUMBER________________________________

PARENT’S CELL PHONE NUMBER_________________________________