Medical & Insurance Information
List any medical info you want us to know about during the event that will helps us serve you, especially in an emergency: Food allergies & dietary restrictions (ex: vegetarian), drug allergies, medical conditions, medicines you are currently taken. Describe any allergy, reactions, seriousness, & management.
Consent to Participate & Liability Release
I understand that I am legally responsible for my personal actions for the entire time I am at this event. I recognize the inherent risk associated with the various activities that I will be participating in. I agree on behalf of myself, my heirs, successors, and assigns to indemnify, defend, and hold harmless Our Lady of Angels and the Roman Catholic Diocese of Dallas, their employees and/or volunteers from any and all claims (unless due to the Sole or Gross NEGLIGENCE of the Parish) for illness, injury, death, and the cost of medical treatment therewith, arising from or in any way connected with my participating and/or attending the various programs and activities during this event. In the event any legal action is taken by either party against the other party to enforce any of the terms and conditions of this release, it is agreed that the unsuccessful party to such action shall pay to the prevailing party therein all reasonable court costs, reasonable attorneys� fees and expenses incurred by the prevailing party.
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Media Consent & Social Media Communications
On occasion, video recordings, audio recordings, photographic slides, and photographs are taken of children and youth during church and diocesan sponsored activities. These are utilized in newsletters, websites, event promotion, advertisements and other printed media. As the State of Texas does not prevent audio or video recording or the photographing of children/youth For good and valuable consideration, I hereby grant to Our Lady of Angels Catholic Church the irrevocable and unrestricted right to make, use and/or publish any and all photographs, videos, and other images of me/my minor child or images in which Student may be included, now existing or hereafter made, in any case, with or without identifying Student for editorial, advertising, news, or any other purpose and in any manner and medium; to alter the same without restriction; and to copyright the same. On behalf of myself and/or my child, I specifically waive all rights to privacy and confidentiality with respect to name, likeness, voice, photographs, images, video recordings, audio recordings and identifying information. I hereby release and agree to fully and unconditionally protect, indemnify, and defend Our Lady of Angels, the Roman Catholic Diocese of Dallas, and their respective officers, agents, and employees, (collectively, �Indemnitees�) and hold each Indemnitee harmless from and against any and all costs, expenses, attorney�s fees, claims damages, demands, suits, judgments, losses, or liability for injuries to property, injuries to persons (including Student) and from any other costs, expenses, attorney fees, claims, suits judgments, losses, or liabilities of any and every nature whatsoever arising in any manner, directly or indirectly, out of, in connection with, in the course of, or incidental to the use or publication of any photographs, videos, or other images of Student, REGARDLESS OF CAUSE OR OF THE JOINT, COMPARATIVE, OR CONCURRENT NEGLIGENCE OF THE INDEMNITEES.
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We are very appreciative that you are volunteering your time to chaperone this retreat! If you can pay $85 to help cover your expenses, that would be appreciated. The Pines charges OLA $145 per adult, so if you can pay that amount, it would be appreciated as well.
Electronic Signature for Agreements