Holy Week Under 18 Permission Slip

Holy Week Under 18 Permission Slip

Holy week under 18 permission slip Form Preview
Holy Week Under 18 Permission Slip
  • Permission to Participate in Activities 2014-2015 Mission Network Activities USA, INC

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  • Nature and Duration of Activities: Mission work including prayer, Mass, preparing and running kid's camps, various assistance in parish activities, door to door missions in neighborhoods close to parish, evening activities with the other missionaries, and various corporal or spiritual works of mercy. Registration begins at 6:30 P.M. Wednesday,  April 1st, 2015, and the Mission ends after the Easter Vigil on April 4th, 2015   

  • 1. Activity Supervisors

    Priests of the Legionaries of Christ, Consecrated women of Regnum Christi, Adult chaperones, college-aged volunteers.
  • 2. Transportation

    Transportation is not provided by Mission Network Activities USA, Inc itself. Some volunteers have offered to drive their vehicles to carpool the missionaries. By signing below you acknowledge and accept transportation from individual members and not by Mission Network Activities USA, Inc itself.
  • 3. Mentoring

    Participants may be offered mentoring, which is intended to help young people personalize the principles of Christian living that they receive at home and in club activities. Mentoring involves a private conversation with an adult conducted in plain view of others. When dealing with adolescents, confidentiality will be maintained to foster openness of dialogue, but situations involving sexual abuse of a minor or threats to life or physical health will be reported to the appropriate authority and to the parents (except in those cases where the parent may be the alleged abuser).
  • 4. Requirements

    The child named above is in good health and has no physical or medical limitations that would cause the activities as described above to be detrimental or dangerous to the child. Parents/guardians should specify allergies and medical problems in section above.
  • 5. Consent

    I hereby attest that I am (we are) the legal parent\guardian(s) of the above-named child and hereby consent to the child's participation in the activities described above. I/We warrant that I/We have full authority to legally consent to his/her participation in the activities described on this form, and all provisions described therein. I understand that activities of the kind described above may result in physical injury to my child but nonetheless specifically request that he or she be allowed to participate in those activities.
  • 6. Authorization:

    I/we hereby authorize Mission Network Activities USA, Inc to use the image and likeness of my/our child in photograph or video form whether taken by or commissioned by Mission Network Activities USA, Inc in its promotional materials and for its promotional purposes associated with its non profit activities. This authorization shall extend to use of my/our child's image and likeness on the website of Mission Network Activities USA, Inc or its successor in operation or affiliated organization(s) upon written consent of Mission Network Activities USA, Inc. I/We understand that this authorization shall survive the end of my/our child's participation in the activities referenced on this form.
  • 7. Emergencies

    If the above-named child requires any emergency medical treatment or procedures during the activities, I/we hereby consent to the activity supervisor(s) taking, arranging for or consenting to such procedures or treatments in the discretion of the activity supervisor(s). For purposes of such procedures and treatments, my/our child's blood type, allergies, or other medical problems, if any, are listed above.
  • 8. Insurance

    I/We understand that Mission Network Activities USA,Inc. does not carry any insurance relative to the activities or for any injury that may occur to the above-named child. I/We represent that the child is (a) covered by insurance through my own insurance carrier; or (b) that I/We am personally financially responsible for any and all medical costs incurred as a result of the child's injury.
  • 9. Emergency Contacts

    If, in the event of a medical or other emergency, I/we am/are unable to be reached by telephone at the numbers listed above, I/we authorize the activity supervisor(s) to attempt to contact me through the emergency contacts listed below.
  • Parent/Guardian Contact Information

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  • Emergency Contact Information

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  • 10. Release and Indemnification

    I/We release and waive, and further agree to indemnify, hold harmless or reimburse Mission Network Activities USA,Inc. and Consolidated Catholic Administrative Services, Inc. the individual members, agents, directors, officers, employees, volunteers, and representatives thereof, as well as activity supervisors, from and against, any claim which I, any other parent or guardian, any sibling, the above-named child, or any other person, firm or corporation may have or claim to have, known or unknown, directly or indirectly, for any losses (including attorney fees incurred by Mission Network Activities USA, Inc. and Consolidated Catholic Administrative Services Inc. or any of its individual employees, agents, volunteers, etc in enforcing this indemnity provision) with out limitation in time or amount, damages or injuries arising out of, during, or in connection with my/our child's participation in the activities, the traveling to and there from, and the rendering of emergency medical procedures or treatment, if any. I/We understand that this release and indemnification shall survive the end of my/our child's participation in the activities referenced on this form and shall have no limitation in time or amount.
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