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Robotics: gr. 6-8, 2022

Robotics Registration (gr. 6-8)

On Wednesdays for the rest of the school year,

starting January 12, 2022

2:25-3:25 PM

Where: at All Saints Catholic School, Room 5
Dismissal will be at Door J; please be prompt.

Individual in charge: Mr. Dan Ince

Registration and Payment is Due:
Friday, January 7 for the early bird price.

Fees per student: $35 (with a t-shirt) EARLY BIRD PRICE*
$25 (without a t-shirt) EARLY BIRD PRICE*

*After Jan. 7, the fee will be $45 (with a t-shirt)
or $35 (no t-shirt if order has already been placed)

Please send cash or check payment
(payable to All Saints) to the school office.

Full refund will be issued if the activity is cancelled.

For questions, please contact Chris Spinler (952-469-3332 or schoolcentral@allsaintschurch.com).

Parental/Guardian Consent Form and Liability Waiver

Please complete the form below.

As the person completing this form, your signature will be required in four places.

One form per student.

Required fields marked *

Student Name (first and last)*

One student per form

Answer Required

Date of Birth*

Answer Required

Address (include street and city)*

Answer Required

Parent/Guardian Name (first and last)*

Answer Required

Cell Phone Number*

Number Required

Additional Phone Number

Number Required

Email address for communications regarding this activity*

Answer Required

I, the above named parent/legal guardian, grant permission for my above named child, to participate in this parish/school activity that may require transportation to a location away from the parish site. This activity will take place under the guidance and direction of parish/school employees and/or mission partners from All Saints Catholic Church & School. As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor ("participant"). I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend All Saints Catholic Church & School, its officers, directors and agents, and the Archdiocese of Saint Paul & Minneapolis, coaches, chaperones, or representatives associated with the 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 All Saints Catholic Church & School, the parish, its officers, directors and agents, and the Archdiocese of Saint Paul & Minneapolis, coaches, chaperones, or representatives associated with the activity for reasonable attorney's fees and expenses arising in connection therewith.

As guardian, I acknowledge and agree to the conditions above. By typing my signature below, I acknowledge and agree this electronic signature is the legally binding equivalent to my handwritten signature. This electronic signature has the same validity and meaning as my handwritten signature.

Signature #1*

Name of person completing this form (first and last)

Answer Required

MEDICAL MATTERS: I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.*

Answer Required

Yes

Emergency Medical Treatment: In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency, if you are unable to reach me at the above numbers, contact:

Alternate Emergency Contact Name *

Answer Required

Alternate Emergency Contact Phone Number*

Number Required

Signature #2*

Name of person completing this form (first and last)

Answer Required

MEDICAL INFORMATION:

I CONFIRM that I will not send my child to the event unless I can certify on the day that: My child has not had any of the following COVID-19 symptoms that cannot be attributed to another health condition in the last 7 days: fever, difficulty breathing, cough or sore throat AND my child has not in the last 14 days had direct exposure to individuals with COVID-19 symptoms OR diagnosed with COVID-19..*

Answer Required

Yes, I confirm the above.

Parents are responsible for administering any medication to their children before, during or after practices, games or related activities. Medications kept in the Health Office (for use during the school day) will not be available before, during or after extracurricular activities.*

Answer Required

Yes, I understand.

I understand that no medication of any type, whether prescription or non-prescription, may by administered to my child unless the situation is life threatening and emergency treatment is required.*

Answer Required

Yes, I understand.

Medication my child is taking at present. *

If no medications, type "none"

Answer Required

Signature #3*

Name of person completing this form (first and last)

Answer Required

Specific Medical Information: The parish will take reasonable care to see that the following information will be held in confidence.

Family Health Plan Carrier and ID Number*

Answer Required

Family Doctor and Phone Number*

Answer Required

Allergic Reactions (medications, foods, plants, insects, etc.)*

Answer Required

Does this child have a medically prescribed diet?*

Answer Required

Any physical limitations?*

Answer Required

Has this child recently been exposed to contagious disease or conditions, such as mumps, measles, chickenpox, etc.? If yes, give date and disease or condition. *

Answer Required

Special Medical Conditions we should know about:

Answer Required

As parent/guardian, I have read, and I understand and agree to all of the above stated considerations and conditions. By typing my signature below, I acknowledge and agree this electronic signature is the legally binding equivalent to my handwritten signature. This electronic signature has the same validity and meaning as my handwritten signature.

Signature #4*

Name of person completing this form (first and last).

Answer Required