Event: Prayer and Action Mission
Event Date: Week 1: June 13–18 | Week 2: June 20–25 | Week 3: June 27–July 2
Event Location: Savannah
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 acknowledge and agree that my participation in this event may expose me to many inherent risks; including but not limited to the potential exposure to viral illnesses such as influenza, COVID-19, SARS and others. I am aware of the recent global pandemic involving viral illnesses and specifically COVID-19. These are serious and dangerous infections, which could cause grave illness and in some cases death.
I assume all risks associated with my participation in the event. I proceed with participating in the event willingly, voluntarily and with full knowledge and appreciation of these risks, which include close and continued contact with others.
I acknowledge my responsibility to communicate any personal circumstances which might conflict with my ability to safely participate; and I acknowledge that I have a duty and responsibility not to participate if I am concerned for my health and safety, or if my own personal condition poses any risks of harm to others.
By signing below, I acknowledge my understanding of all of the above; and I hereby waive, hold harmless and release the Catholic Diocese of Savannah and its leadership, owners, officers, members, representatives, agents, employees, contractors, successors and assigns from and against any claim for personal injury (including death) or illness of any kind arising out of my participation. I hereby also agree to indemnify and defend the Catholic Diocese of Savannah against any third party claim of an injury alleged to have been caused by or as a result of my participation.
By checking this box and typing your name below, you have agreed that this is your electronic signature.
Any participant with known exposure to COVID-19 shall not be allowed access to camp until at least fourteen (14) days have elapsed since the last known exposure.
Students should not leave camp at any time during the week.
We will have regular on-site screenings to check each camper for any signs of illness. If your child exhibits any signs of illness, they will be isolated and you will be asked to pick them up as soon as possible.
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
Hearing Impaired
Visually Impaired
Mobility Impaired
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:
Medications
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.
Everyone
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.
Participants
Chaperones
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.
Thank you for contacting us! Someone from this office will be in touch with you soon.
Pray for us.
Copyright © 2018 - Diocese of Savannah
