Like to play basketball? Come join the region for a fun day of shooting hoops.
We need both girls and guys to have a team. Sign up if you are interested!
I'll be in touch about exact info once we have a team!
Parish: Our Lady of Mount Carmel Phone:
595-0385x128
Address: 100 Harpersville Road City:
Newport News Zip: 23601
Type of Event: a basketball tournament against teams from other parishes
Destination: Peninsula Catholic High School Date of Trip: November 13, 2004
Time:start around 9am; double elimination, but tournament lasts all day.
Transportation:provide your own
Participant's Name___________________________________________________
Sex Date of Birth Age__________________________
Parent/Guardian's Names______________________________________________
Home Address____________________________________________________
City State Zip___________________
Home Phone Work Phone_______________________
Number parent/guardian can be reached on date of event_____________________________
Emergency Contact Person Phone___________________
Relationship to participant_____________________________________________________
I (parent,/guardian above) grant permission for my child participant above) to participate
in this parish youth ministry even that requires transportation to a location away from the parish
site. This activity will take place under the guidance and direction of the parish employees and/or
volunteers. A brief description of the activity is give at the top of the page.
As parent and/or legal guardian, I remain legally responsible for any personal actions taken
by my child. I agree on behalf of myself, my child name herein, or our heirs, successors, and
assigns, to hold harmless and defend this Parish (listed above), its officers, directors, and
agents, and the Diocese of Richmond, Virginia, chaperones, or representatives associated with
this event, arising from or in connection with my child attending the event or in connection with
any illness or injury or cost of medical treatment in connection therewith, and I agree to compensate
the parish, its officers, directors and agents, and the Diocese of Richmond, chaperones, or
representatives associated with the event for reasonable attorney's fee and expenses arising in connection there within.
Signature Date
(Note: Does the youth minister have a copy of your medical release form on file? (You
filled one out if you registered for RE this year). If not, make sure you get one filled out before the trip.
Parents, we need adults to help out. Please mark down if you can be one of the following:
__scorekeeper __coach __referee