Youth Trip Release Form - Church Of The Nativity printable pdf download

PARENTAL/GUARDIAN CONSENT FORM AND LIABILITY WAIVER

Participant’s Name____________________________________________

Parent/Guardian’s Name_______________________________________ Home Phone________________

Parent(s) work/cell phone(s) _______________________________________________________________

I ___________________________, grant permission for my child __________________________ to participate in

_________________________________(activity), on ____________________(date). I understand that staff and

volunteers of the Church of the Nativity will lead and chaperone this activity and transport my child to the event in personal

vehicles or walk.

For value received, I agree on behalf of myself, my child’s other parent, or guardian, my child named herein and/or our

heirs, successors, and assigns, to release, indemnify and hold harmless and defend the Archdiocese of Kansas City in

Kansas, the Church of the Nativity, and their priests, directors, officers, agents, representatives, volunteers, employees or

representatives associated with this event with respect to any and all actions, claims or demands that may be brought

against them arising from any injury or damage resulting from this event, and I agree to compensate the Archdiocese of

Kansas City in Kansas, the Church of the Nativity and their priests, directors, officers, agents, representatives, volunteers,

employees or representatives for attorney fees and expenses incurred as a result of any such injury or damage, unless such

claim arises from their negligence of those released.

Medical Matters: I hereby warrant that to the best of my knowledge my child is in good physical and mental health, and I

assume all responsibility for the health of my child.

If any emergency would arise, I can be most easily reached through the following means:

________________________________________________________________________________________________

Specific Medical Information: Reasonable care will be taken to see that the following information will be held in

confidence.

Any physical limitations? __________________________________________________________________________

You should also be aware of these special medical conditions of my child: ___________________________________

_______________________________________________________________________________________________

I fully understand the consequences of the foregoing statements and sign this Parental/Guardian Consent Form and

Liability Waiver knowingly, freely, and willingly

Parent Signature: ________________________________ Date: _____________________

Youth Trip Release Form - Church Of The Nativity