TEEN MINISTRY PARENTAL CONSENT

September 1, 2023 through August 31, 2024
Participant’s Name(Required)
MM slash DD slash YYYY
* OK to receive texts?(Required)
Address

I and/or my son or daughter or ward named below (collectively and each a “Participant”) would like to join the group from Holy Family Catholic Community, Inverness, IL (“Parish”) during its participation in Teen Ministry activities (collectiviely the “Event”) taking place from September 1, 2023 through August 31, 2024.

Participant hereby agrees to forever release and discharge the Parish, The Catholic Bishop of Chicago, an Illinois corporation sole and all of their affiliates, clergy, employees, agents, volunteers, successors and assigns (“Archdiocesan Parties”) from and against any and all claims, damages or liabilities resulting from or related to the Event and/or any personal injury, loss of life or damage of property sustained by Participant at or in any way related to the Event.

Participant hereby agrees that personnel of the Archdiocesan Parties may authorize or perform medical treatment if they believe that it is necessary for Participant’s health, safety and well-being. In the event of an injury or illness which requires immediate examination or treatment in the opinion of Archdiocesan Parties, Participant hereby authorizes the Archdiocesan Parties to have Participant transported by car or ambulance to the nearest hospital at Participant’s sole risk, cost and expense and Participant agrees that necessary emergency treatment may be given by any hospital personnel on call. If this occurs,

Participant hereby agrees that the efforts of the Archdiocesan Parties to contact Participant’s family as soon as practical after injury or illness occurs shall be satisfactory, whether before or after treatment. Participant hereby understands and agrees that the Archdiocesan Parties assume no financial responsibility for ambulance conveyance or medical expenses incurred by Participant during, or resulting from, the Event and that the Archdiocesan Parties do not carry medical expense insurance for the benefit of Participant.

Participant agrees to obey all local, county, state and federal laws, rules and regulations while at this Event and will also comply with the rules and regulations stipulated to Participant by personnel of the Archdiocesan Parties in relation to the Event. In the event Participant violates the terms of this Agreement, Participant acknowledges that he/she may be required to obtain their own transportation home from the Event.

Participant hereby agrees and authorizes the Archdiocesan Parties to use and reuse Participant’s image, likeness and voice recording in any photograph, video recording and/or audio recording (collective “Recordings”) for the purposes of education, marketing or promotion of the Archdiocesan Parties without compensation or notice to Participant and the Recordings may be used within the websites, social media sites, brochures, magazines, books or other communication materials of the Archdiocesan Parties at any time.

Parent/Guardian 1(Required)
Parent/Guardian 2
Emergency Contact Name(Required)
Authorized Physician
MM slash DD slash YYYY

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