Type of Event: FCA Fields of Faith
Date/Time of Event: Wed Oct 5, 2022 meet at St. Pius V at 7:15pm walk to the John Burch Park together and walking Return by 8:30pm
Destination: John Burch Park – Cannon Falls
Individual(s)/Teacher(s) in Charge: Cindy Meyers, Kati Moline and Catechists
Mode of Transportation To and From Event: Walking in a group
Other Information: dress appropriately for the weather. If weather permits going to the park, Fields of Faith will move to St. Pius V.
BY CHECKING THE BOX - I GIVE MY CHILD/CHILDREN PERMISSION and By filling out this form, I am agreeing to all the permissions. 1) PARENTS: I GIVE MY PERMISSION FOR MY CHILD/REN to participate in the Church of St. Pius V Faith Formation and Youth Ministry classes/activities. In consideration of my Child’s/ren’s participation, I agree to indemnify the Church of St. Pius V and the Archdiocese of St. Paul/Minneapolis from any claims or law suits brought against the parish/school/ Archdiocese of St. Paul/Minneapolis by myself, my child/ren or others, that arises out of any behavior by my child/ren at the Faith Formation and Youth Ministry classes/activities. I also agree to pay reasonable attorney’s fees or expenses incurred by the Church of St. Pius V and Archdiocese in defense of such a claim/law suit. 2) CONSENT AND PERMISSION TO TREAT MINOR In the event of an emergency, I give permission to transport my child/ren to a hospital for emergency medical treatment. I wish to be advised prior to any further treatment by a doctor or hospital. 3) PHOTOGRAPH/PRESS RELEASE I realize that photographs, videos, written extractions, and voice recordings of program participants the purpose of may be taken during various activities for illustrations, publications, live stream on YouTube, social media platforms, and St. Pius V website/Archdiocese website. No home address or phone number will be published;. By signing this form, I hereby authorize and give full consent to Church of St. Pius V to publish and copyright all photographs, videos, written extractions, and voice recordings in which my child appears while participating in any Faith Formation/Youth Ministry activities. IN CASE OF INJURY OR ILLNESS YOUR OWN MEDICAL INSURANCE WOULD BE USED. MEDICAL INSURANCE PROVIDED BY THE PARISH OR THE ARCHDIOCESE IS LIMITED & IN EXCESS TO ANY OTHER VALID and COLLECTIBLE INSURANCE. Further, I hereby warrant that to the best of my knowledge, my child is in good health and I assume all responsibility for the health of my child. I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and
defend St. Pius V, its officers, directors, employees and agents, and the Archdiocese of Saint Paul and Minneapolis, its employees and agents, chaperones, or representatives associated with the event and activities (hereinafter “Releasees”), from any claim, including but not limited to all claims relating to communicable disease, arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate Releasees for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of Releasees.
I/we the undersigned, have read all releases and understand all its terms and execute it voluntarily and with full knowledge of its significance. I/we the undersigned, have read all releases and understand all its terms and execute it voluntarily and with full knowledge of its significance. Print name.
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