Saturday, February 18, 2012 
1:00PM 6:
00PM 

St. Elizabeth Ann Seton Parish 

All high school teens are welcome to join John for an afternoon to 
prepare us for Lent. John is a Catholic musician who will share stories, 
prayer and music. The day will conclude with mass at 5:00PM. 

Cost of the event is $5.00 (please make checks payable to the Archdiocesan Deposit and Loan) 

For more information contact 
your youth minister. 

Photos may be taken during this event and 
shared for publication and publicity purposes. 
If you wish to keep your photo confidential, 
please notify the directors of this program. 

JohnhasperformedatnumerousNCYC’saswellasattheArchdiocesanyouthrallyin2010.
FormoreinformationaboutJohnvisitjohnangotti.com
This event is brought to you by St. Elizabeth Ann Seton 
Parish and CRAYM. 

RegistrationformsaredueFEBRUARY8thdueFEBRUARY8thdueFEBRUARY8thdueFEBRUARY8thSendformsand$5.00toSt.JohntheBaptistParishSarahCasey2127thSt.SEBox169MountVernon,IA52314

Off-site/Field Trip Permission Form 

School/Parish/Program Name: A Journey Into Lent for Teens With John Angotti 

Date: February 18, 2012 
Person in Charge: CRAYM Grades: 9-12 
Event and Purpose: A mini retreat to prepare for Lent 
Time of Event: 1:00pm-6:00pm Cost: $5.00 

Section 1 -By signing this section, I (parent/guardian) certify that I request and give my permission 
for________________________________________________ to attend this 

(name of student/participant) 
event. Further, I have previously completed the Annual Parental/Guardian Consent Form and Liability 
Waiver and agree to the conditions as set forth. 

Parent/Guardian Signature:_____________________________________Date: __________ 

Contact Phone number(s) _____________________________________________________ 

Section 2 -Nonprescription Medication Permission -By signing this section, I hereby grant permission 
for nonprescription medication (such as ibuprofen, Tylenol, throat lozenges, etc.) to be given to my 
child. 

Parent/Guardian Signature:_____________________________________Date: __________ 

Section 3 -Please list (continue on reverse side if needed) any medical information important for the 
adult in charge to know and/or any changes in this child’s medical condition or 
emergency contact information since the completion of the Annual Parental/Guardian 
Consent Form and Liability Waiver. 

Archdiocesan Policy 5141 covers the administration of prescription medication; contact the program 
administrator for additional information. 

Please return this permission slip by February 8, 2012 

Supervisor’s Signature _________________________________________________________________________ 
(Principal, C/DRE, Youth Director, Pastor, etc.) 

This is the only permission slip that will be accepted for this event.
Please detach and save for your information/reference.


School/Parish/Program Name: A Journey Into Lent for Teens With John Angotti 

Date: February 18, 2012 
Person in Charge: CRAYM Grades: 9-12 
Event and Purpose: A mini retreat to prepare for Lent 
Time of Event: 1:00pm-6:00pm Cost: $5.00