St. Anselm’s Abbey School

A Catholic, Benedictine School for Boys Grades 6 - 12

Life at the Abbey

"...toward a balance in mind, body, and spirit."

Form IV Activity Day Permission

St. Anselm’s Abbey School
Form IV Activity Day
Parental Consent, Waiver, and Medical Permission Form

I give my permission for my son to attend and to participate in St. Anselm’s Abbey School Form IV Activity Day/Rafting Trip to be held on October 4th, 2019. The day will include travel from St. Anselm’s Abbey School to Great Falls, Virginia, and then from Potomac, Maryland, back to St. Anselm’s. I understand that while attending the activity my child will be under the supervision of the staff of St. Anselm’s Abbey School. On my behalf and on behalf of my child, I hereby release St. Anselm’s Abbey School, its officers, members, employees, assistants, contractors, servants, volunteers, and helpers, from any and all liability for damage or injury to any person or property during my son’s affiliation with, and/or attendance on the activity day, or during travel to, from or in connection with the activity day, whether or not such damage or injury is sustained in connection with the activity day. I further agree to indemnify and save harmless St. Anselm’s Abbey School from any and all further claims, demands, costs and/or expenses arising out of any such injuries or damages.

The School should have all of your son’s medical information through the Magnus System. If you have not updated the information, please contact Zach Delgado (202-269-2353, zdelgado@saintanselms.org) to do so.

In case I cannot be reached I hereby authorize Mr. Bill Crittenberger, Headmaster, St. Anselm’s Abbey School, 4501 South Dakota Avenue, N.E., Washington, DC, 20017 and his appointed representatives on this event to consent to any X-ray, examination, and anesthetic, medical, or surgical diagnosis or treatment, and hospital care, to be rendered to my son at a recognized medical facility, under the general or special supervision of a licensed physician or surgeon.

Permission Form