First & Last Name of Teen Volunteer *
Age as of June 24, 2023 *
First & Last Name of Parent/Guardian
Address *
City *
State *
Zip Code *
Cell phone number of Parent/Guardian *
Email of Parent/Guardian *
Home Parish *
Allergies or other medical conditions of teen volunteer *
Medical Insurance Company and Policy Number of teen
Family Physician’s Name
Physician’s Phone Number
Activity & 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, the Salesian Sisters, and the Diocese of Colorado Springs. I consent for any of my children listed below to participate in any activity or trip sponsored by the Diocese of Colorado Springs or its affiliates* (collectively, “the Diocese”). In case of medical need, I authorize the Diocese to arrange for medical or dental services for me and any of my children listed below. I agree that any such expense will be my obligation. Waive, release, and indemnify the Diocese 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 diocesan 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. * “Affiliates” includes all Diocesan parishes, missions, schools, and ministries and also Catholic Charities of Colorado Springs, Inc., Partners in Housing, Inc., Ave Maria Catholic School Corporation, the Catholic Foundation of the Diocese of Colorado Springs, Inc., and the Institute of the Daughters of Mary Help of Christians (Salesian Sisters) 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.
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