Youth 2000 Retreat Liability Release Form Release Of All Claims Page 2
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2Parish/School/Group Leader Form for Chaperone Accountability
WITH THE YOUTH 2000 RETREAT
Each group attending that is bringing young people under the age of 18 must fill out this form
(only one form per group needed).
Name ________________________________________________________________________________
Parish/School/Group Contact in charge of the group filling out this form
Cell Phone______________________ E-Mail_________________________________________
Parish Name _________________________________________City______________________________
State _________ Zip ____________ Parish/School/Group phone number________________________
Chaperone Accountability
There must be one adult chaperone for every six youth, age 17 and younger, in your group.
______Number of youth in your group, age 17 and younger, attending the YOUTH 2000 Retreat
______Number of chaperones attending the YOUTH 2000 Retreat with your group.
Names of adult chaperones for your group:
1. _______________________________________________________________
2. _______________________________________________________________
3. _______________________________________________________________
4. _______________________________________________________________
5. _______________________________________________________________
6. _______________________________________________________________
7. _______________________________________________________________
8. _______________________________________________________________
9. _______________________________________________________________
10. ______________________________________________________________
All chaperones and volunteers with youth under the age of 18 MUST submit the following
documents – No Exceptions:
1. Signed and completed YOUTH 2000 Liability and Release Form
2. If you are from outside of the Fort Worth Diocese, a letter from your parish or Diocese stating that each
chaperone/volunteer with youth is in compliance with the Charter for the Protection of Children and Youth, USCCB – that
you have completed the safe environment training required by your diocese and a current background check. Attach the
letter to your completed YOUTH 2000 Liability Release Form. If you are from within the Fort Worth Diocese, your
compliance status will be checked on the data base, no paper documentation is required.
Note: Online Certificate will not suffice.
3. Form D, G, and H from the Diocese of Fort Worth
------------------------------------------------------------------------------------------------------------------------------------
For Registration Committee Use Only
Fort Worth Diocese compliance verified or letter received for each out of diocese chaperone listed
above: Yes ______No______
Received by (Registration Committee Volunteer name):_________________________
Date _________
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