Student Name:       

I am the parent or guardian of above said student. (Only Parent or Guardian may submit this form).

Parent/Guardian Name:  

Student Medical Conditions or Special Notes:

Parent/Guardian Home Phone Number:  

Parent/Guardian Cell Phone / Pager Number:  

Online Registration Indicates Acceptance of the Following Consent:
I hereby give permission for my child listed above to attend to attend the Class Trip to New York City on the scheduled (or any rescheduled) day and to be transported by plane, school bus, private bus, public transportation, van or private vehicle(s) as determined by the school. For myself and the named child; I hereby waive and release any claim against Holy Spirit Preparatory School and its board, employees, servants and agents for any injury or loss incurred by my child during the field trip (save for any personal injury directly resulting from gross negligence on the part of the school) and agree to indemnify the school against any expenses, loss or damages incurred as a consequence of any action or inappropriate inaction on the part of my child. I confirm that there are no medical or other circumstances that should be known to the chaperone(s) that are not noted on the reverse of this permission slip.

This Student's Registration will not be complete until your payment is submitted on the following screen.