St. Pius X – Open Skating at the Rec Center, February 28, 2016
Registration Form for Students 6-12th Grade
St. Pius X youth, families and friends are invited to join us for ice skating at the Rec Center from 1-3pm. Come join us for an afternoon of fun to meet more St. Pius X families and young people!
Location: Rochester REC Center - 21 Elton Hills Drive, Rochester, MN 55901.
Time: 1:00pm-3:00pm
Registration forms can be turned in to the St. Pius X parish office any time before February 26th or inside the main entrance of the REC Center on the 28th.
Youth Name: ______Grade: ___
Youth Name: ______Grade: ___
Youth Name: ______Grade: ___
Emergency Contact Information:
Name: Phone Number:
Cell Phone #: Email
My child is in generally good health: Yes No
Allergies or other Special needs/concerns:
$5/person enclosed, payable to St. Pius X Catholic Church (waived for chaperones)
WAIVER
I give permission for my child to take part in the Open Skating Day at The REC Center.I assume all risks and hazards incidental to participation and hereby release, absolve, indemnify and agree to hold harmless the REC Center, Diocese of Winona, MN, St. Pius X and its agents, employees and the chaperones, leaders, organizers and sponsors of this activity.Neither the Diocese of Winona, St. Pius X Church, the REC Center nor any of said persons shall be held financially responsible for any injury, illness or death incurred as a direct or indirect result of this activity.
I, the undersigned, have read this release and understand all its terms and execute it voluntarily and with full knowledge of significance.In the event of an emergency and I cannot be contacted, I hereby authorize that emergency treatment be administered.
Parent Name(Please print)______
Parent Signature______Date:_____
VOLUNTEERS NEEDED!
Parents and adults age 21 + are encouraged to chaperone. VIRTUS training is required for all chaperones – the next one in Rochester is on January 25th. Please contact St. Pius X parish for more information or go to register for a training.
Volunteer Name: Email:
Phone:
Note: All volunteers age 18 years & up must complete Virtus training and submit a consent of background check form to their parish prior to the event. Register for Virtus @virtusonline.org.
Chaperone shifts available: Circle any that you may be able to help with. Free admission for you and/or one youth if you work one shift.
Registration: 12:40pm-1:20pm Skate Rental: 12:40pm-1:20pm
Activity Room Chaperone: 1pm-3pmIce Rink Chaperone: 1pm-3pm
Activity Room Food/Drink Help 12:45pm-3pm
Turn completed form and payment in to the St. Pius X Church office by 2/26/16
IMPORTANT!! Please complete both sides of this form.
Expectations for youth all planning to attend:
We recommend you leave valuables at home ~ no one will be supervising attended purses or coats.
~Stay in designated areas of the REC Center – The ice rink and the activity room.
~Dress appropriately for iceskating. Hats, mittens, and layers are recommended.
~Be respectful of everyone using the ice – all ages and ability levels will be present.
~Respect the property of others, including the building.
~All snacks and drinks will be provided and should only be consumed in the activity room.
~Parents will pick up youth from the REC Center at 3pm.
I agree to abide by the above guidelines.If I behave inappropriately, my parents will be called and I will be sent home with them.
Student’s signatureDate Parent’s signature Date
Please return this form and payment of $5/participant to the church office by February 26th.Checks should be payable to St. Pius X Church.After 2/26, you may still register but should bring all registration materials to the event.
For questions, please Katie Stinson at .