Cedar Point Registration Form - The Roman Catholic Churches of Southern Fayette

Youth Day Cedar Point

July 29th Youth Day Cedar Point for the Region

Step 1 of 2

Contact Details

Name(Required)

Youth First Youth Last

Grade

Church

Age

Shirt Size

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Parent’s Email Confirm Email

Parent's Phone(Required)

Youth Cell Phone(Required)

Permission to text youth while on the trip ONLY?(Required)

Medical Illnesses or Allergies(Required)

Prescription Medications Needed:(Required)

Emergency Information

Parent / Legal Guardian Names(Required)

Emergency Contact Name(Required)

Emergency Contact Phone Number(Required)

Medical Insurance Company(Required)

Policy Number

Payment Details

Trip Cost

Price: $135.00

Click Link Below to make Payment

https://www.osvhub.com/st-therese-uniontown/giving/funds/youth-day-at-cedar-point

Signature(Required)

Permission Form I hereby consent to participation for the above named child(ren) in the event described above. I understand that if stated, this event will take place away from the Church grounds and that my child(ren) will be under the supervision of the designated parish employee on the stated date(s). I further consent to the conditions stated above on participation in this event, including the method of transportation. In case of emergency, we give permission for our child(ren) to be treated at a hospital and/or by a medical doctor.

Signature(Required)

In consideration for providing my child(ren) the opportunity to attend formation and parish activities and any related transportation to and from the parish, both my child(ren) and I voluntarily agree to release and agree to hold Parishes AND DIOCESE OF GREENSBURG harmless from, and waive on behalf of myself/my child(ren), my heirs, and any personal representatives, any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself/my child(ren) that may be caused by any act, or failure to act of the Parishes AND DIOCESE OF GREENSBURG or that may otherwise arise in any way in connection with my child(ren)’s attendance at a parish/diocesan event to the fullest extent allowed by law. I understand that this release discharges the Parishes AND DIOCESE OF GREENSBURG from any liability or claim that I/my child(ren), my heirs, or any personal representatives may have against the parish/ diocese with respect to any bodily injury, illness, death, or medical treatment that may arise from, or in connection to, my child(ren)’s attendance at the parish or event. This liability waiver and release extends to the Parishes AND DIOCESE OF GREENSBURG together with its clergy, staff, and volunteers. I certify and represent that I have the legal authority to waive, discharge, release, and hold harmless the released parties on behalf of myself and the above-named student.

Signature

I hereby grant to the Diocese of Greensburg, Pennsylvania, and its respective licensees, successors and assigns, the right and permission, with respect to those photographs taken of the minor named below on whose behalf I am signing, and with respect to any printed or electronic matter in connection therewith, to do the following: 1. To include such photographs on the Diocese of Greensburg website, Parishes website, and on print material 2. To use the name of the minor on whose behalf I am signing, in connection with the foregoing. I hereby release, discharge and agree to indemnify and hold harmless the Diocese of Greensburg and its legal representatives, licensees, successor and assigns, from all claims and demands whatsoever arising out of or in connection with the foregoing, and waive any right to inspect or approve the same. I hereby certify that I am the above said minor under the age of eighteen years, and hereby consent on behalf of said minor to the use of any of the photographs taken of said minor pursuant to the terms set forth in this Photographic Release, including, without limitation, the release, discharge and hold harmless provisions thereof.