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Corn Maze

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More Information

Join us to escape one of four mazes at northwest Indiana's largest corn maze! We'll meet at CBS the pray a rosary at 6:30PM, then challenge each other to escape a corn maze (or just meander the Jurassic Park-themed routes). Parents will pick students up from the corn maze at approximately 9:30PM.
Student Sign Up
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- Student Name REQUIRED Please fill out this field. Please enter valid data.
- Student's Birth Date REQUIRED Please fill out this field. Please enter valid data.
- Student's Sex REQUIRED Please fill out this field.
- Parent / Guardian Name REQUIRED Please fill out this field. Please enter valid data.
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- Parent / Guardian Phone Number REQUIRED Please fill out this field. Please enter valid data.
- Parent Email REQUIRED Please fill out this field. Please enter valid data.
- Church of the Blessed Sacrament Parishioner REQUIRED Yes No, just visiting Please fill out this field.
- I, [Parent / Guardian's name] grant permission for my child, [Child's name] to participate in the parish event that requires transportation to a location away from the parish site. This activity will take place under the guidance and direction of parish employees and/or volunteers from Church of the Blessed Sacrament.
  
  A brief description of the activity follows:
  Type of Event: Corn maze
  Date of Event: Friday, October 27, 2023
  Destination of event: Exploration Acres in Lafayette, IN
  Individual in charge: Erin Del Busto
  Estimated time of departure and return: 7:00PM departure, 9:30PM return
  Mode of transportation to and from event: car
  
  As a parent and/or legal guardian, I remain legally respondible for any personal actions taken by the above named minor ("participant").
  
  I agree on behalf of myself, my child named herin, or our heirs, successors, and assigns, to hold harmless and defend the Church of the Blessed Sacrament, its officers, directors, employees and agents, and the Diocese of Lafayette-in-Indiana its employees and agents, chaperones, or representatives associated with the event, from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatmet in connection therewith, and I agree to compensate the parish, its officers, directors and agents, and the Diocese of Lafayette-in-Indiana, its employees and agents and chaperones, or representative associated with the event for reasonable attorney's fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the parish/diocese.
  
  By checking the "I Agree" box below, you are legally agreeing to all of the statements written above.
  
  I Agree Please select this field.
- Date REQUIRED Please fill out this field. Please enter a date.
- Medical Matters: I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. (Of the following statements pertaining to medical matters, sign only those that are applicable.)
  
  Emergency Medical Treatment: In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency, if you are unable to reach me at the above number, contact:
- Name & Relationship Please enter valid data.
- Phone Number Maximum 20 characters Please enter a phone number.
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- Phone Please enter valid data.
- Family Health Plan Carrier Please enter valid data.
- Policy # Please enter valid data.
- Type your name here to represent your signature Please enter valid data.
- Date Please enter a date.
- Other Medical Treatment: In the event it comes to the attention of the parish, its officers, directors and agents, and the Diocese of Lafayette in Indiana, chaperones, or representatives associated with the activity, that my child becomes ill with symptoms such as headache, vomiting, sore throat, fever, diarrhea, I want to be called colelct (with phone charges reversed to myself).
- Type your name here to represent your signature Please enter valid data.
- Date Please enter a date.
- Medications: My child is taking medication at present. My child will bring all such medications necessary, and such medications will be well-labeled. Names of medications and concise directions for seeing that the child takes such medications including dosage and frequency of dosage, are as follows:
- Medications and directions for child taking medications
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- Date Please enter a date.
- No medication of any type, whether prescription or non-prescription, may be administered to my child unless the situation is life-threatening and emergency treatment is required.
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- Date Please enter a date.
- I hereby grant permission for non-prescription medication (i.e. non-aspirin products suchas acetaminophen or ibuprofen, throat lozenges, cough syrup) to be given to my child, if deemed appropriate.
- Type your name here to represent your signature Please enter valid data.
- Date Please enter a date.
- Specific Medical Information: The parish will take reasonable care to see that the following information will be held in confidence.
- Allergic reactions (medications, foods, plants, insects, etc.) Please enter valid data.
- Immunizations: Date of last tetanus / diptheria immunization Please enter valid data.
- Does child have a medically prescribed diet? Please enter valid data.
- Any physical limitations? Please enter valid data.
- Is child subject to chronic homesickness, emotional reactions to new situations, sleepwalking, bedwetting, fainting? Please enter valid data.
- Has child recently been exposed to contagious disease or conditions, such as mumps, measles, chicken pox, etc.? If so, list date and disease or condition. Please enter valid data.
- You should be aware of these special medical conditions of my child: Please enter valid data.
- Photo Release
  I give permission for my child(ren) to be photographed during the 2023-24 academic year. I realize that photos / video may be published in the bulletin, newspaper, website, or other publication for informational / educational purposes only. Children will not be identified by name.
- Photo Release REQUIRED Yes No, do not publish any photographs of my child. Please fill out this field.
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Corn Maze

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