First & last name of parent/ guardian *
Street address *
City *
State *
Zip *
Cell phone *
Home phone *
E-mail *
Teen 1) First & last name *
Teen 1) Allergies or other medical conditions *
Teen 2) First & last name
Teen 2) Allergies or other medical conditions
Person to contact in case of emergency *
Phone number *
Waiver release: by typing your name below, you agree to the following statements: *
For all parents, all guardians and all those 18 years of age or older. Please read the following statements carefully. By typing your name above, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this Agreement. By typing your name in the box, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature, and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting agreement between you and the Salesian Sisters.: I consent for any of my children listed on this registration form to participate in any activity or trip sponsored by the Institute of the Daughters of Mary Help of Christians (Salesian Sisters) or its affiliates* . In case of medical need, I authorize the Institute of the Daughters of Mary Help of Christians (Salesian Sisters) to arrange for medical or dental services for me and my children. I agree that any such expense will be my obligation. I, individually, and in my capacities as parent/guardian of my child(ren), waive, release, and indemnify the Institute of the Daughters of Mary Help of Christians (Salesian Sisters) and its agents, directors, officers, employees, and volunteers (Collectively, the “Released Parties”) from all claims or liability which have arisen or may arise from any activity or trip and which involves any damage, loss, or injury to me, my spouse, any of my children, my property, or the property of any of my children. In the same capacities, I promise not to sue any of the Released Parties for any such claims or liability. This waiver, release, indemnification, and promise not to sue does not apply to claims of criminal conduct or gross negligence. This Activity release is revocable prospectively only by a written statement signed by me which bears the date that the revocation is delivered to the Diocese. * “Affiliates” includes the Institute of the Daughters of Mary Help of Christians (Salesian Sisters).
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