Totus Tuus: Holy Saints ACC Registration

Parent Name *

First Name Last Name

Email *

example@example.com

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Please enter a valid phone number.

Emergency Contact Name: First Name* Last Name*
Emergency Contact Number: Area Code* Phone Number*

Name of Child *

First Name Last Name

Grade Entering Into Fall 22 *

Any Allergies/ Medical Conditions we should be aware of? *

What Sacraments has your child received? *

Baptism First Communion Confirmation Not Catholic

Medical Authorization:
I understand that the Diocese of St. Cloud and Totus Tuus assume no responsibility for accidents which may occur in association with diocesan events and activities. I agree to use my own personal insurance to cover any such incidents. I understand that in the event in which medical intervention is needed, every attempt will be made to contact the Emergency Contacts listed above. In the event those individuals are not able to be reached, I hereby give permission to any qualified medical staff selected by the even leader to hospitalize, secure medical treatment, and/or order injection, anesthesia, or surgery for Participant as deemed necessary.

Release of Liability for Youth and Adult:

I understand all reasonable safety precautions will be taken at all times by the diocese of Saint cloud and Totus Tuus and its employees and Holy Saints ACC volunteers during the events and activities. I understand the possibility of unfussy hazards and know the inherent possibility of risk. I agree to indemnify and hold harmless the Catholic Diocese of Saint Cloud and Totus Tuus, its leaders, as employees and volunteer staff from any and all claims arising from or in connection with attending this event.

Code of Behavior for Youth and Adults

I agree to abide by and or instruct my child to abide by all rules and regulations as outlined by the aforementioned chaperones/representatives. I agree that if participants fail to abide in any way by the rules, that participant can be dismissed from the event and sent home immediately at my expense with no right of reimbursement or refund for any amount in connection therewith from the Diocese of Saint Cloud or its chaperones/representatives.

Photo Release:

I give permission to the Diocese of St. Cloud and Holy Saints ACC to utilize photographic/video images of myself or child. In giving permission, I hereby indemnify and hold harmless the Diocese of St. Cloud, Holy Saints ACC, and Totus Tuus and its agents from any and all responsibility of liability. I understand that I will receive no compensation should any photograph.video be used.

If I do not give permission for my child to be photographed, I will notify Kelli Kleinschnitz (lead organizer) when my child does initial sign in at the event.

Signature of Parent/Guardian

Signature

Clear

Date: