YOUTH RELEASE LANGUAGE
As the parent/legal guardian of
________________________________, permission is hereby granted for my
son/daughter to participate in the Covered Bridge Bike Tour 2015 produced by St
Anthony Shrine (hereafter "Bike Tour") on Sunday, May 3, 2015 being held at
Thurmont town park in Frederick County, Maryland. I knowingly, voluntarily and without
reservation and on behalf of myself, my child, my heirs, and my estate, hereby
RELEASE, INDEMNIFY, DEFEND AND HOLD HARMLESS Our Lady of Mount Carmel,
Thurmont, Roman Catholic Congregation, Incorporated; St. Anthony Shrine,
Emmitsburg, Roman Catholic Congregation, Incorporated (“St. Anthony”); the
Roman Catholic Archbishop of Baltimore and his successors, a Corporation Sole,
and each of their affiliate organizations, agents, employees, officers,
directors, volunteers, officials, students, and other participants
(collectively, the “Church”) from any liability, claims, demands and causes of
action arising out of or relating to any loss, damage or injury (including
death) sustained in connection with or arising out of my child's participation
in the Bike Tour, including the cost of any medical care given to me or any
expenses or fees including attorneys’ fees incurred in any lawsuit or claim
arising as a result of any damage or injuries incurred by or caused by me in
the course of my participation in the Bike Tour. By my signature below, I understand and
acknowledge that my child’s participation in the Bike Tour involves inherent
risk of minor or serious injury, including permanent disability, death, and/or
economic losses which might result from my child’s actions or inactions, the
negligence of others, and the inherent risks of the Bike Tour and its
activities. I have voluntarily elected to allow my child to participate, and I fully understand, appreciate, and hereby assume all such dangers and risks.
I understand that my child’s participation in the Bike Tour may require a minimum level of fitness for safe participation, and that the Church does not screen, medically or otherwise, individuals that
participate in the Bike Tour. I acknowledge that it is my sole responsibility to make certain that my child is physically fit and healthy enough to participate in the Bike Tour. In the case of a health emergency or need of urgent healthcare involving my child, after a reasonable effort has been made
to contact me (or if the urgency of the circumstances does not permit an effort
to contact me), I authorize and consent to any medical care deemed necessary
for the health and safety of my child. I request and authorize physicians, dentists, and duly licensed health care professionals and staff to perform any diagnostic procedures, treatment
procedures, operative procedures and x-ray treatment on the above minor. I have not been given a guarantee as to the results of examination or treatment. I authorize the hospital or medical facility to dispose of any specimen of tissue taken from the above-named minor.
I recognize and acknowledge there is no accident coverage nor is there any medical payments coverage available to me in order to compensate me for expenses I incur from deductibles, co-payments,
prescription drugs, or medical services not covered through my own health
insurance provider(s) for any injury my child sustains as a result of the Bike
Tour. I agree that any medical coverage(s) I have will be primary and under no circumstance will I seek any contribution from the Church, or their insurer, for any medical expenses.