Conference Registration
Consent Form and Liability Waiver
I, as the parent or legal guardian of the child named in this form, grant permission for my child to participate in the Steubenville Youth Conference July 10-12. In exchange for and in consideration of the opportunity for my minor child to participate in the activity sponsored by Saint Ambrose Parish, I agree to the following:
I understand the scope and nature of the Steubenville Youth Conference, that the Youth Conference involves transportation to and from the service site in Steubenville, Ohio. I understand my child will be transported to the conference by car or bus. I acknowledge that I have the opportunity to contact Caitlin Arbogast at 330-460-7387 or CArbogast@StAmbrose.us with any questions prior to submitting this form.
I recognize, as with any activity, the possibility and risk of injury associated with my child's participation in the activity. I understand that such injuries can occur for any number of reasons which are both foreseeable and unforeseeable and which include, but are not limited to, my child's own actions or inaction, the actions or inaction of others (whether negligent, intentional, or otherwise), and equipment failure.
I and my spouse assume, for ourselves and on behalf of our minor child, all risks in connection with my child's participation in the Youth Conference. To the fullest extent allowed by law, I, on behalf of myself, my spouse, my minor child, as well as our respective heirs and assigns, executors, all other legal representatives and any others claiming through us or on behalf of us, hereby agree to release, discharge, hold harmless and indemnify Saint Ambrose Parish, the Roman Catholic Diocese of Cleveland, the Bishop of the Roman Catholic Diocese of Cleveland, as well as their respective clergy, officers, employees, agents, representatives, attorneys, sponsors, and volunteers from and against all claims, judgments, liability (of any nature or extent) which in any way arise out of or relate to my child's participation in the activity, whether foreseen or unforeseen, regardless of the cause (including, but not limited to, the negligence of any person).
I understand that it is my responsibility to carry appropriate medical insurance for my child and that such is not the responsibility of any other person or party, including, without limitation, Saint Ambrose Parish or the Diocese of Cleveland.
Emergency Medical Authorization Form
Enter "NONE" if not applicable.
Enter "NONE" if not applicable.
This authorization enables the parent or guardian of a minor participant to authorize the provision of emergency treatment for the participant who becomes ill or injured while attending the activity sponsored by Saint Ambrose Parish and while in the care of or under the supervision of the Parish or its staff, employees, volunteers, agents and/or representatives when the parent or guardian cannot be reached. This must be signed in order for your child to participate.
In the event reasonable attempts to contact me at the provided numbers have been unsuccessful, I, the legal parent/guardian of the child named in this form hereby authorize any of the staff, employees, volunteers, agents and/or representatives of Saint Ambrose Parish to provide for, seek, and authorize medical treatment for him/her in the case of illness or accident from the closest and most appropriate licensed medical practitioner or hospital available.
This authorization does not cover major surgery unless the medical opinions of two licensed physicians/dentists concurring in the necessity for such surgery are obtained for the performance of such surgery.
Any and all information concerning the child's history including allergies, medications and physical impairments, has been reported in these registration forms. In the event of an emergency, I authorize any authorized party to share the completed registration information packet with persons related to the treatment of my minor child.
Photo Release and Authorization
I (we) the parent(s) and/or guardian(s) of the minor child identified in this form hereby grant Saint Ambrose Parish and/or its agents consent to record (in writing or otherwise), photograph, audiotape, or videotape my minor child's name, image, likeness, or spoken words, in any form, and to display, release, exhibit, publish, or distribute the same, or any part thereof, for any lawful Parish use or purpose including, without limitation, use on the Parish's websites, social media sites, print and electronic media, marketing publications, public relations and communications materials and/or presentations, and any other uses as may not be contemplated herein, without further notice or compensation.
I further release the Parish, the Diocese of Cleveland, and the Bishop of the Diocese of Cleveland and their respective officers, employees, agents, representatives, and volunteers, from liability for what I might deem a misrepresentation of me by virtue of alterations, optical illusions, or faulty mechanical reproduction, and other claims, damages, loss, or causes of action related to the lawful use of any material obtained by the Parish in accordance with my consent.
Finally, in signing below I acknowledge that all recordings, audiotape, videotape, photographic proofs, photographic negatives, positives, and prints created pursuant to this Release shall constitute the sole property of the Parish.
Payment
