St. Bede’s Middle School Youth Group
LASER TAG
When:
Saturday, Januray 11,2014
Time:
6:30-8:30pm
Where:
UltraZone
4201 Neshaminy Blvd. #130 Benslem, PA 19020
Price:
$20.00 per person
Includes:
2 games of Laser Tag
Pizza & Soda
Friends welcome!!!!!!!!!!
Join us on
Saturday, January 11th 2014
6:30-8:30 PM
for a fun evening of
Laser Tag
at
ULTRAZONE
Neshaminy Square Shopping Center
4201 Neshaminy Blvd #130
Bensalem, PA
215-396-9936
$20 per person
~ covers 2 Games of laser tag, pizza and drinks ~
Arcade games are extra so bring money if you want to play
FEEL FREE TO INVITE YOUR FRIENDS!
PLEASE RSVP BY --- JANUARY 5TH, 2014
Submit payment with a completed permission slip in an envelope marked “Laser Tag”
to the Youth Ministry mailbox in the parish office.
Make checks payable to St. Bede's the Venerable Church
--------------------------------------------------------------------------------------------------------------------Name _______________________________ Grade: _________ School ___________
Enclosed is my payment of $ _____________
( ) Parent would like to chaperone
( ) Attached is my permission slip
( ) Please e-mail me a registration form so I may become a member of the youth group
( ) Please add my e-mail address to the youth group mailings so I may be kept up-todate with future activities/events. e-mail address:_______________________________
Any questions or if any parents would like to chaperone, please e-mail Maritza at
[email protected]
St. Bede’s Middle School Youth Group
Parental Permission & Release Form
My child(ren) _______________________________________________
has/have my permission to participate in The Laser Tag trip at ULTRAZONE
on Saturday, January 11, 2014. My child will meet at Ultra Zone (4201
Neshaminy blvd., Bensalem) at 6:30pm. The group will play 2 games of laser
tag. Pizza and beverages are included. Students will have time to play the
arcade games. Arcade games are an additional cost. Student pick up is at
8:30pm. Parents will provide transportation.to and from Ultra Zone.
I hereby agree to indemnify and hold harmless St. Bede the Venerable Church,
the Archdiocese of Philadelphia, and its officers, employees, and volunteer staff
from any liability. I accept responsibility for any medical expenses as a result of
any such injury sustained.
___________________________________________ ____________________
Parent/Guardian Signature
Date
_____________________ _________________________________________
Home
Mother’s Cell Phone
________________ ___________________
Emergency Contact (*not parent)
Father’s Cell Phone
__________________________
Emergency No.
*Note: We will attempt to contact Parent/guardian(s) FIRST. Please indicate someone other
than parent/guardian that we can contact if you cannot be reached.
St. Bede the Venerable Middle School Youth Group
Medical Release
To Whom It May Concern:
As a parent/guardian, I do herewith authorize the treatment by a qualified and
licensed medical doctor in the event of a medical emergency, which in the
opinion of the attending physician, may endanger his or her life, cause
disfigurement, physical impairment or undue discomfort if delayed. This authority
is granted only after a reasonable effort has been made to reach me.
This release form is completed and signed of my own free will with the sole
purpose of authorizing medical treatment under emergency circumstances in my
absence.
____________________________________
Parent/Guardian Signature
____________________
Date