Liability Waiver & Medical Authorization Form - Parish Of Massachusetts


Liability Waiver & Medical Authorization Form
___________________ Parish of _____________, Massachusetts (the “Parish”)
Acknowledgement and Assumption of Risk
The undersigned participant, parent and/or legal guardian, does hereby acknowledge that I am or he/she is
aware of the dangers and risks to person and property by participating in:
Nevertheless, I, or the undersigned parent and/or legal guardian, voluntarily elect to participate in this
activity with knowledge of the danger involved, and hereby agree to accept and assume any and all risk of
property damage, personal injury, or death.
Medical Authorization, Indemnification and Waiver of Liability
In consideration for being allowed to voluntarily participate in the above-referenced event, I hereby:
a.) Consent to receive medical treatment, which may be deemed advisable in the event of injury,
accident or illness during this activity or event. This release, indemnification, and waiver shall be
construed broadly to provide a release, indemnification, and waiver to the maximum extent
permissible under applicable law;
b.) Agree to defend, indemnify, and hold harmless the Parish and the Roman Catholic Archbishop of
Boston, a Corporate Sole, and its agencies, officers, and employees from and against any and all
claims of any nature including all costs, expense and attorneys’ fees, which in any manner result
from actions during this activity or event; and
c.) Waive and release forever the Parish and the Roman Catholic Archbishop of Boston, a Corporate
Sole, and its agencies, officers, and employees from any and all liability for death, disability,
personal injury, property damages, property theft, or claims of any nature which may hereafter
accrue as a direct or indirect result of the participation in the activity or event.
Further, I affirm that I am at least 18 years of age and am freely signing this agreement. I have read this
form and fully understand that by signing this form I am giving up legal rights and/or remedies that may
otherwise be available regarding any losses sustained as a result of participating. I agree that if any
portion is held invalid, the remainder will continue in full legal force and effect.
Signature: _______________________________________________
Date: ___________________
Printed Name: _______________________________________________________________________
Name of Minor, if applicable: _______________________________
Age of Minor: ____________
Emergency Contact Telephone No.: ______________________________________________________
Insurance Carrier Name and Policy No.: ___________________________________________________
Important Medical Information About Your Child (allergies, etc.):   _ ________________________________________  


00 votes

Related Articles

Related forms

Related Categories

Parent category: Business