YOUTH 2000 REGISTRATION
Includes
lunch and dinner on Saturday
Does NOT include housing
- Registration is $50 per person
if mailed after March 30 -
Mail
Registration Fee & this
completed Liability Release Form with checks payable to:
St. Patrick Cathedral 2000, 4433 Fair Ridge Drive, Aledo, TX 76008, or return to your youth leader.
***LIABILITY RELEASE FORM BELOW
MUST BE COMPLETED & SIGNED FOR ALL PARTICIPANTS ***
Name of Activity: YOUTH 2000 Retreat
Telephone: Registration:
817-244-7733
registration@stpatrickcathedral2000.com
General
Information: 817-558-9805 stpatrickcathedral2000.com
Date of Activity: April 13, 14, 15, 2007 (Feast of Divine Mercy)
The undersigned do
hereby release, forever discharge and agree to hold harmless YOUTH 2000, Inc.,
the Diocese of Fort Worth, St. Patrick Cathedral and Nolan Catholic High School from and against any and all
liability, claims, demands, lawsuits and expenses of any kind arising from
personal injury, sickness, death or property damage of any kind whatsoever
which may be incurred or suffered by the undersigned and/or participant (if
participant is under 18, 18 or older).
The undersigned
further agree to indemnify and hold YOUTH 2000, Inc., the Diocese of Fort Worth,
St. Patrick Cathedral and
Nolan Catholic High School and their respective members, directors, employees,
and agents (collectively, the "Indemnities,") harmless from and against
any and all claims, demands, actions, lawsuits, and liabilities, including
attorney fees and expenses and costs sustained by the Indemnities as a result
of negligent, willful or intentional acts of the undersigned and/or participant
(if participant is 18 or under, 18 or older).
If participant is
under 18 years of age, I the parent or legal guardian of the
participant, do hereby grant permission for our child to participate fully in
the YOUTH 2000 Retreat and all of its activities. In the event that
neither the chaperone nor I can be reached, I hereby give permission to the
agents of YOUTH 2000, the Diocese of Forth Worth, St. Patrick Cathedral and Nolan
Catholic High School to take said participant to a doctor or hospital and
hereby authorize medical treatment, including but not limited to emergency
surgery and I fully and completely assume all responsibility for all
medical bills.
Further, should it be necessary for the participant to
return home due to medical reasons, disciplinary action or otherwise, I
assume all responsibility and transportation costs.
This form MUST be signed by
ALL participants. If participant is under 18, parent or legal guardian must
sign.
As a chaperone representing parish, by signing below, I (name) hereby declare that I have fulfilled all the diocesan requirements pertaining to chaperones at parish, on (date.)
Parent or Legal Guardian Signature _____________________________________Date______________
Participant’s Signature (if 18 or older) ___________________________________Date______________
NOTE: ANY PARTICIPANT UNDER 18 YEARS OF AGE MUST HAVE (1) A DESIGNATED LEADER/CHAPERONE ( 1 leader
to 6 participants) and (2) WRITTEN PERMISSION SIGNED BY A PARENT OR LEGAL GUARDIAN IF
PLANNING TO LEAVE THE RETREAT DURING RETREAT HOURS. (Chaperone must accompany minor with note to door monitor) All
chaperones must fulfill and be in compliance with their Diocesan policies and
requirements for providing a safe and secure environment for minors.