This document appears to be a break form for a parish youth movement. It requests the name of the person taking a break, the dates of the break, and the reason for the break. The form is signed by the youth animator.

1. PARISH YOUTH MOVEMENT
BREAK FORM
NAME :
FROM : TO:
REASON FOR BREAK
Yours truly YOUTH ANIMATOR
PARISH YOUTH MOVEMENT
BREAK FORM
NAME :
FROM : TO:
REASON FOR BREAK
Yours truly YOUTH ANIMATOR