Release of Liability

  Activity: ___________________________________  

  Date: _____________________________________

  Name:  ____________________________________ 

  Emergency Phone #: _________________________

  Address:  __________________________________

I hereby grant permission for my child to attend this Youth Ministry Event.  As parent or as legal guardian, I remain legally responsible for any actions taken by the above named minor participant.  I release, discharge and covenant not to sue St. Gerald Parish or any of its directors, officers or chaperones associated with this event  In case of emergency, I give my permission to seek medical attention for my child.

Signature of Parent or Guardian:

_______________________________________________

Date: __________________________________________

Insurance Information:

_______________________________________________

I am a representative of St. Gerald Parish and the Parish Young Program.  I will conduct myself in a manner which will reflect a positive image of myself, the Parish and the Youth Program.

__________________________________________