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Event: Diocesan Youth Conference (DYC)
Event Date: 1/31/20 – 2/02/20
I voluntarily agree to participate in the above described event. This activity will take place under the guidance and direction of employees/volunteers from my parish/school/organization named above. I also understand that my child’s participation requires transportation to/from the event site, and this transportation is arranged by my parish/school/organization leaders.
For value received, I agree to hold harmless and defend my parish/school/organization named above, its officers, directors, employees and agents, and the Diocese of Savannah, its employees and agents, chaperones, or representatives associated with the event, from any claim arising from or in connection with my 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 my parish/school/organization named above, its officers, directors and agents, and representatives associated with the event, for reasonable attorney’s fees and expenses which they may incur in any action brought against them as a result of such injury or damage.
I hereby warrant that to the best of my knowledge I am in good health, and I assume all responsibility for my health.
Wheelchair Access Needed
Emergency Medical Treatment
In the event of an emergency, I hereby give permission to be transported to a hospital for emergency medical or surgical treatment. In such an event, please contact:
Specific Medical Information
I am not taking any medication at present.
I am taking medication at present. I will bring all such medications necessary, and such medications will be well-labeled. Names of medications, dosage and frequency of dosage, are as follows:
Each chaperone, participant and Young Adult Helper must agree to these rules. Chaperones, please read carefully as you will be asked to enforce these policies.
PHOTO RELEASE FOR INTERNET AND NEWSPAPER: I hereby grant permission for photographs taken of me at this event to appear on one of the communication mediums of my parish/school/organization (bulletin, newsletter, website, etc.) and/or the Catholic Diocese of Savannah (e.g., The Southern Cross or diocesan websites)l. I understand that these images will be used only in relation to these publications and this event. Any other use of said images will require my full written consent.
I have read and understand the above consent form and I agree to abide by these rules. I understand that failure to abide by these rules could result in my being asked to leave the event.
By checking this box and typing your name below, you have agreed that this is your electronic signature.
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