I am the parent or legal guardian of the participant named on the previous page of this online form. I hereby release- and forever discharge- The Orthodox Church in America (OCA), the OCA Diocese of New York and New Jersey, the OCA Diocese of New York and New Jersey's Department of Youth Ministry, and each and every one of its agents (hierarchs, employees, volunteers, insurers, attorneys, or any other person(s) associated with them) from any and all liability, for all personal injuries known or unknown that the youth named may incur due to reasons unrelated, but not limited to, negligence by participating in activities conducted, sponsored, or associated with the event stated above.
I understand that the coordinators reserve the right to remove any participant, chaperone, or volunteer from the event should said individuals engage in any behavior deemed to be unacceptable, including bullying, the use or possession of illegal drugs or weapons, use of alcohol, or participating in inappropriate sexual behavior.
In the event of an emergency I, or a responsible party, may be reached at the following telephone numbers:
Also, in the event that I cannot be reached in the case of emergency, I do hereby authorize a physician selected by the coordinator of this event to administer emergency treatment including medications, diagnostic tests, surgery, or other medical intervention deemed necessary by the physician.
I, the undersigned, have read this release and understand all its terms. I execute it voluntarily on behalf of myself and the participant named above and with full knowledge of the significance to bind all persons. In witness whereof, I consent to this release by digitally printing my name below:
I, the Parent/Guardian of the participant named above, hereby authorize and consent to the use of his/her visual image by the Orthodox Church in America (OCA), the Diocese of New York & New Jersey, and the OCA’s Diocese of New York & New Jersey Department of Youth Ministry for appropriate purposes, including but not limited to: still photography, video, electronic and print publications, the OCA’s Diocese of New York & New Jersey Department of Youth Ministry social media pages on Facebook, Instagram, YouTube, and websites.