Register permission form electronically below or print a paper form here.
Type of Event: FCA Fields of Faith
Date/Time of Event: Wed Oct 13, 2021 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, Mary Waldschmidt 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 & COLLECTIBLE INSURANCE. I acknowledge and understand, the novel coronavirus, COVID-19 has been declared a worldwide pandemic by the World Health Organization. Further, that COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. I also acknowledge, that federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited or limited the congregation of groups of people. I agree, represent and warrant that neither the undersigned, nor any registered participant child(ren) shall visit or utilize the facilities, programs, activities, or services of St. Pius V, Cannon Falls, Minnesota within 14 days after (1) returning from outside the United States, (2) exposure to any person returning from outside the United States, or (3) exposure to any person who has a suspected or confirmed case of COVID-19. I hereby agree, represent and warrant that neither the undersigned nor any registered participant child(ren) shall visit or utilize the facilities, programs, activities, or services of St. Pius V, Cannon Falls, Minnesota if he or she (1) experiences symptoms of COVID-19, including, without limitation, fever, cough or shortness of breath, or (2) has suspected or diagnosed/confirmed case of COVID-19. The undersigned agrees to notify St. Pius V, Cannon Falls, Minnesota immediately if any of the foregoing access or use restrictions may apply. St. Pius V, Cannon Falls, Minnesota has put in place preventative measures to reduce the spread of COVID-19. I agree to comply with measures that St. Pius V, Cannon Falls, Minnesota may require to best protect against the introduction of viruses at St. Pius V, Cannon Falls, Minnesota including, but not limited to, hygiene practices and temperature screening, related to myself and/or my child(ren St. Pius V, Cannon Falls, Minnesota cannot guarantee that I or my child(ren) will not become infected with COVID-19. I understand and agree that attending St. Pius V, Cannon Falls, Minnesota could increase my risk and my child(ren)’s risk of contracting COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by participating in programs of or attending St. Pius V, Cannon Falls, Minnesota) and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at St. Pius V, Cannon Falls, Minnesota may result from the actions, omissions, or negligence of myself and others, including, but not limited to, St. Pius V, Cannon Falls, Minnesota employees, volunteers, and program participants and their families. 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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