Medical Release
I request that the above named participant be allowed to attend event listed above. In the event of an illness, I request that the designated volunteer or Director of Youth Ministry obtain medical treatment on my behalf for my teen if I or the emergency contact cannot be reached. Prescription medication will be given in its original container with dosage information on it. I understand reasonable precautions will be taken to safeguard the health and well-being of my teen and that I will be contacted immediately in case of emergency or accident. I will not hold the Parish, Diocese of Phoenix, the Chaperone or Director of Youth Ministry responsible for accident or injury.
Behavior Agreement
My teen, named above, will dress and act respectively; use no verbal or physical abuse of self or others; will not have in their possession at any time, alcohol, drugs or tobacco of any kind; will be responsible for their own belongings; will not leave the designated area at any time for any reason without contacting the adult in charge; and will review the these guidelines with me, their parent, prior to signing below. I understand that if the teen named above is involved in any illegal activity or serious destructive behavior that I will be contacted immediately and be responsible for their immediate transportation home.
COVID-19 Participation Waiver
I give permission for (the student listed above) to attend St. Bernard of Clairvaux parish Retreat realizing that there is some potential for injury and illness inherent in such all Parish activities. I acknowledge that Parish is using is good faith, reasonable efforts to implement the recommendations of the Centers for Disease Control and Prevention (CDC), Arizona Department of Education, and state and local health authorities in light of the unique needs and circumstances of the Parish community, and in order to allow for in-person learning while protecting students, teachers, administrators, and staff and helping slow the spread of COVID-19. While the CDC states that these efforts help lower the risk of COVID-19 exposure and spread during parish sessions and activities, they cannot eliminate all risk of exposure and transmission, and Parish cannot ensure my child’s complete safety.
By allowing my child to attend the Parish in person, therefore, I specifically acknowledge and assume the risks and hazards associated with my child’s participation in all parish activities, but not limited to, the risks associated with the novel COVID-19 virus. I understand that my child will be associating with, teachers, administrators, staff and other children and may contract COVID-19, and other viruses and diseases, through my child’s participation in activities at parish. I understand and voluntarily assume the risk that my child may acquire COVID-19, and that COVID-19 may subsequently be transmitted from my child to me, my family, and members of my household.
I certify that my child is in good health and has no current issues that make it unsafe for my child to participate in Parish activities, which may not have a medical professional on staff. I will notify the Parish and not send my child to Parish or Parish functions if my child develops a fever or other symptoms of illness or tests positive for COVID-19. Furthermore, I will not send my child to Parish or Parish functions if my child is sick, has COVID-19 symptoms, or has been in close contact with someone who shows symptoms of or has been diagnosed with COVID-19 until after a 14 day exposure period has been exhausted for my child with no symptoms. I further agree that I will follow, and will take reasonable steps to ensure that my child will follow, all rules, policies and guidelines of Parish in order to protect other students, teachers, administrators, and staff and help slow the spread of COVID-19.
To the fullest extent permitted by law, I hereby agree to waive, release, and discharge any and all claims, causes of action, damages, and rights of any kind against the Parish, the Diocese of Phoenix, their insurers, and all of their respective employees, agents, representatives, and volunteers (the “Released Parties”) arising from or relating in any way to any injury or illness, including those related to COVID-19, that may occur to my child, me, or my household members due to my child’s participation in the Parish activity.