March for Life 2020

Institute of Christ the King

March for what You Stand for!
This form allows you to sign up for the following bus:

Pittsburgh

For 1 day round trip:

Registered Parishioner: $40
ICKSP Member: $50
Non-Parishioner: $70

Registration deadline: January 7, 2021
Participant Name *

First Name Last Name
Gender *

Female Male
Date of Birth *

Month Day Year
Date
Will the registrant be a MINOR on the first day of the trip? *

YES, he/she will be an ACCOMPANIED Minor NO, he/she is not a Minor
Local Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Mobile Phone Number in order to reach you during the trip *

Area Code Phone
Email (Do not provide a minor’s email if you do not permit its use by the Institute.) *
example@example.com
Special Needs and /or Considerations (Such as Food Allergies, Other Allergies, Medical Conditions, Special Needs, Handicaps, and/or Limitations, Prescription Medications – Important Note: All prescription medications must be disclosed!
Special Needs and/or Considerations

Please contact me (parent/guardian) regarding any special considerations listed in this section
Which Bus will you be taking? *

Bus 1 (families and others): Boards at 5:45am at MPBOJ Bus 1 (families and others): Boards at 6:45am at Walmart (park on the right side of building, lot for lawn and garden) 915 Mills Drive North Huntingdon, PA 15642. Bus 2 (Young Adults over 18 and any others over 18): Boards at 5:45am at MPBOJ

Information for Minors

For Accompanied Minor only
Minors must be accompanied by an adult chaperone at ALL times, including on the bus. If the registrant is a MINOR, what is the name of the adult chaperone that will be accompanying the minor?
Supervision of Minors

Institute activities involving minors must meet the following standards:
- All members, staff and adult volunteers who supervise minors must be in compliance with the safe environment requirements of their respective (Arch)diocese.
- No fewer than two adult supervisors must be present at all Institute activities involving minors (including transportation to and from Institute activities); more supervision might be necessary to meet adult:child ratios for a specific event, to be determined by the Institute member who is in charge of the event.
- Under no circumstances may a minor be placed in a supervisory role over other minors . It is the responsibility of adults to properly supervise the minors in their care.
Photo Use Policy:

As an integral part of its mission, the Institute may take or acquire photographs that communicate news about the implementation of it mission and vision. These photographs may be routinely published in printed and digital publications and training materials, and/or on its website or other social media platforms. The Institute is committed to the responsible use of these photographs. Under no circumstances will the Institute knowingly publish photographs that could be an embarrassment, cause scandal, or bring discredit to the Institute or the individuals in any photograph. Neither full names nor contact information will be published alongside any photographed adult without the individual’s prior written consent, and no image of an individual will be used in any fundraising appeal without that individual’s prior written consent. Attribution credit will be given when required by applicable copyright laws. As a courtesy, and to the extent possible, the Institute will decline to use an image, or will promptly remove an image, upon request. In some circumstances, however, it may be impossible to accommodate such a request, as for example when the image is of a large group at a public event.

By permitting a minor to participate in the Institute’s public events, such as Masses, Baptisms, Confirmations, performances, community outreach projects, and similar events, parents and guardians will be deemed to have consented to the Institute’s policy. For private events, parents and guardians will be asked to provide written permission for the use of the minor’s image in a manner consistent with this policy at those events.

Email and Texting Policies for Minors:

Members, staff, and adult volunteers who wish to conduct text, email or online conversations with minors age 13 or below must do so only through their parent’s accounts. Members, staff, and adult volunteers who wish to conduct text, email or online conversations with minors age 14-17 must copy the minor’s parent or guardian on all such communications.

Also note that any Institute employee or adult volunteer who receives a "friend request" on his personal social media account from a minor affiliated with the Institute is required by Institute policy to reject the request, unless specific permission is granted by the superior and the individual’s parent or guardian. Similarly, members of the Institute may not use any personal social media accounts in their work for the Institute; members may only use social media accounts owned by the Institute itself.
Policy *

I have read the policy and will abide by it.

Health Insurance Information
Name of Insured
Health Insurance Provider
Insurance Company
Policy Number
Emergency Contact Information
Primary Contact Name *

First Name Last Name
Primary Contact Relationship to Participant *
Relationship
Primary Contact Phone Number(s) *
Primary Contact Email
example@example.com
Secondary Contact Name

First Name Last Name
Secondary Contact Relationship to Participant
Relationship
Secondary Contact Phone Number(s)
Secondary Contact Email
example@example.com
Release and Waiver of Liability Agreement
The participant desires to participate in the annual March for Life trip to Washington, D.C. (“MFL”), sponsored by the Institute of Christ The King Sovereign Priest (“Institute”). This Release and Waiver of Liability Agreement covers the entirety of my participation in the MFL, including travel in order to participate in activities associated with the MFL.

1. Risk Factors: The undersigned understands and acknowledges that the use of equipment and facilities provided by the Institute in participation in the MFL involves risks including, but not limited to the following: risk of property damage, bodily injury, including, but not limited to permanent disability, paralysis, and possibly death. These risks may result from a variety of circumstances including, but not limited to, the use or misuse of equipment or facilities, from the activity itself, from the acts of myself or others, including the Institute and its agents or from the unavailability of emergency medical care.

2. Assumption of Risk: The undersigned assumes full responsibility for all risks that may arise out of or may result from participation in the MFL, including but not limited to, those risks described in Section 1, above. Except from this section are any injuries caused by the gross negligence or willful or wanton misconduct of any officials, officers, employees, agents, or volunteers of the Institute.

3. Acknowledgment of Policies and Procedures: The undersigned acknowledges that I have read, know, and agree to all of the policies and procedures relating to my participation in the MFL. The undersigned understand that the safe and proper use of all facilities, equipment or participation in the activity is dependent upon carefully following these policies and procedures. The undersigned agrees to comply with and abide by all rules, regulations and policies of the MFL. The undersigned understand that the Institute reserves the right to revoke or terminate participation in the MFL for any violations of these rules, regulations, or policies, or for any misbehavior.

4. Release, Indemnify, and Defend: The undersigned hereby releases, waives, discharges and holds harmless the Institute, and all of their affiliates, predecessors, successors, trustees, officers, directors, faculty, employees, agents, and representatives, past or present ( hereinafter jointly referred to as “the released parties”) from any and all claims, suits, liabilities, judgments, costs, and expenses (“claims”) for any property damage, property loss or theft, personal injury or illness, death or other loss arising from or relating to participation in the MFL. The undersigned also agrees to defend, indemnify, and hold harmless the Released Parties from and against any claims arising from or related to the undersigned’s own acts or omissions in connection with participation in the MFL.

5. Photography Consent. The undersigned consents to the use of the participant’s image in a manner consistent with the Institute’s Photo Use Policy.

6. Payment for Damages: The undersigned agrees to pay for any and all damages to any property or Released Party caused by the undersigned, negligently, willfully or otherwise.

7. Consent for Emergency Treatment: The undersigned consents to medical treatment for emergencies that occur during or are related to participation in the MFL where the undersigned is unable to consent to such treatment. The undersigned understands that the provisions of this Release and Waiver of Liability Agreement apply to any treatment that might be provided to me under any of these sections within this agreement.

8. Insurance: The undersigned understands that I am solely responsible for any medical, health or personal injury costs relating to my participation in the MFL. The undersigned understands that I am strongly encouraged to have a medical physical examination and purchase health insurance prior to any and all participation in the MFL.

9. Jurisdiction: This Release and Waiver of Liability Agreement shall be governed in all respects by the laws of the State of Illinois. The parties agree to use the State of Illinois for jurisdiction for any disputes between the parties related to this Release and Waiver of Liability Agreement.

10. Severability: If any term or provision of this Release and Waiver of Liability Agreement is held to be illegal, invalid, or unenforceable, or the application thereof to any person or circumstance shall to any extent be illegal, invalid or unenforceable, under present or future laws effective during the terms hereof or of any provisions hereof which survive termination, then in any such event, it is the express intention of the parties that the remainder of this Release and Waiver of Liability Agreement, or the application of such term, clause or provision other than to those as to which it is held illegal, invalid or unenforceable, shall not be affected thereby, and each term, clause or provision of this Release and Waiver of Liability Agreement and the application thereof, shall be legal, valid and enforceable to the fullest extent permitted by law.

The undersigned has read and fully understands this Release and Waiver of Liability Agreement and understands that it relates to surrendering and releasing valuable legal rights. The undersigned does so freely and voluntarily.
Name of Registrant

First Name Last Name
Signature

Clear
Date Signed

Month Day Year
Date
Consent and Release on Behalf of Minor by Parent/Legal Guardian

I am the parent or legal guardian of the above named minor. I have read and understand this Release and Waiver of Liability Agreement in its entirety and understand that it relates to surrendering valuable legal rights of the minor and myself. I agree to be bound by all the terms of the Release and Waiver of Liability Agreement. I also give my consent to the participation in the MFL of the minor.
Name of Parent or Legal Guardian Signing This Form

First Name Last Name
Parent or Legal Guardian E-Signature

Clear
For signiture above use curser (or finger if using tablet or phone) to electronicly sign in the box on the black line.
Date Signed

Month Day Year
Date

What dinner sandwich will you order? CASH ONLY PLEASE. Please order here and insert your order and exact cash into your envelope marked "MFL MEAL" Please place envelope in mail slot at Priory or put in collection box in church.

Egg salad sandwich, pickle, french fries, cole slaw, and drink. $8.00 Chicken salad sandwich, pickle, french fries, cole slaw, and drink. $8.00 Tuna salad sandwich, pickle, french fries, cole slaw, and drink. $8.00 New York panini (roast beef, Swiss cheese, sauteed onions, sliced tomatoes, and thousand island dressing), french fries, cole slaw, pickle, and drink. $11.00 New York panini (turkey, Swiss cheese, sauteed onions, sliced tomatoes, thousand island dressing), french fries, cole slaw, pickle, and drink. $11.00 Tuna salad panini with tomatoes, onions, and melted American cheese, and drink. $11.00

Institute of Christ the King

March for what You Stand for!
My Payment Options
I would like to pay

Online Payment (PayPal Credit Card, Credit or Debit Card) Check via mail to Most Precious Blood of Jesus Parish 3250 California Ave. Pittsburgh, PA 15212 Cash in marked envelope dropped in mail slot at priory or collection box at church

Institute of Christ the King

March for what You Stand for!
Online Payment:

Reserve your spot now by paying online.
I am paying online now (PayPal)
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Registered Parishioner $ 40.00

ICKSP Member $ 50.00

Non-Parishioner $ 70.00

Subtotal $ 0.00 Tax $ 0.00 Total $ 0.00
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Other forms of Payments:

Your spot will be reserved only upon reception of your payment.
I am sending my check/money order now

Pittsburgh Bus: Most Precious Blood Parish (3250 California Avenue. Pittsburgh, Pennsylvania 15212-2362) Memo: March for Life registration
I am paying cash

Cash in marked envelope dropped in mail slot at priory or collection box at church.
I am *

Registered Parishioner: $40 ICKPS Member: $50 Non-Parishioner: $70
Please note, upon registration, payments taken are considered final, and will not be refunded in the event you are unable to attend.

For further information please contact:

412-761-1508

office@mpboj.com
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Institute of Christ the King

Information for Minors

Health Insurance Information

Emergency Contact Information

Release and Waiver of Liability Agreement

Institute of Christ the King

Institute of Christ the King