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Project Shalom 2004
PERMISSION FORM
Your son/daughter is eligible to participate in this Youth Group activity to be held at the parish facilities. This activity will take place under the guidance and the supervision of staff from Christ the Redeemer Church.
| I hereby consent to
participation by my son/daughter,
______________________________________ in the Youth Group
event described on the front of this form. I understand
that this event will take place off of parish grounds and
that my son/daughter will be under the supervision of the
designated parish employee on the stated dates. I consent
to the conditions stated herein of this form including
arrangements for transportation. In consideration of my son/daughter being allowed to participate in this event, I hereby agree on behalf of myself, and my child to release Christ the Redeemer, the Roman Catholic Church and Archdiocese of Detroit, and any and all affiliated organizations, their employees, agents and represetnatives, including volunteer drivers (collectively "Releasees"), from any and all claims including negligence, which may be asserted by me or my child, or on behalf of child, arising from or relating to my child's participation in this event. In the event this release on behalf of my child is held to be invalid or unenforceable, I hereby agree to indemnify and hold harmless Releasees from any and all claims, including negligence, which may be asserted by me or my child or on behalf of my child arising from or relating to my childs' participation in tis event. This release of indemnifications does not apply to claims for intentional misconduct or gross negligence; nor does this release or indemnification apply to the extent of commercial insurance coverage for any cliam, but this Release or Indemnification shall apply to the extent of any self-insurance or deductible applicable to any claim. |
| I will facilitate
this event on Saturday _____ on Sunday _____ Both Days
_____ Home ___________________________ Cell ___________________ Name _________________________ I can take ____ passengers in my vehicle. You will also need to attend the Training Sessions on Sept. 19th & 26th |
______________________________ Print Parent/Legal Guardian Name |
_______________________________ Parent/Legal Guardian Signature |
_________________ Date |
__________________ Phone |
_____________________ Emergency Phone |
| Physician:
________________________________________ Phone:
_____________________ Insurance: ______________________________ Numbers: _______________________________________ |
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| Designated Administrator
of Activity Lynne Anne Huff, Adult Facilitator Location: Lake Orion United Methodist Church and Lake Orion Area Transportation: Carpool Date: Saturday, October 2nd and Sunday, October 3rd Times to be announced at training. |
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