The undersigned do herby request and consent that my child {name} attend and participate in the:

If needed for health reasons, I give permission for my child to be evaluated, diagnosed, treated and/or given medication in accordance with standard medical practice by licensed medical personnel. I authorize an adult, in whose care the minor has been entrusted, to render supervision and to provide consent to any X-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment, and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician, dentist, or emergency medical technician licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital or treatment center whether such diagnosis or treatment is rendered at the office of said physician or said hospital or treatment center.

The undersigned shall be liable and agree to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this request and authorization. The undersigned does also hereby give permission for my child to ride in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in the activities of the CREW - Leaders For Mary Inc. programs.

I give permission to the Directors, Board Members, and any of the VIRTUS Trained Adults of CREW - Leaders For Mary Inc. to photograph, videotape, and/or film my child and to use his or her image in photographs, video, and/or film for the purpose of promoting the mission, activities, and programs of CREW - Leaders For Mary Inc. I understand that I and my child are not entitled to any compensation or rights in these materials, and I release CREW - Leaders For Mary Inc. and any of its Directors, Board Members, and VIRTUS Trained Adults from any liability for the use of my child's image for the above stated purposes.

Please list the following, if applicable:

In consideration for being accepted by the CREW - Leaders For Mary Inc. for attendance at and participation in the activities and associated activities, on behalf of my child participant {name} I hereby assume all risk of personal injury, sickness, death, damage, expense as a result of participation in all activities involved therein.

The undersigned further hereby agree to hold harmless, and indemnify said entities, Directors, Board Members, VIRTUS Trained Adults, parishes, its directors, employees, agents and adult volunteers for any liability sustained as a result of the negligent, willful, or intentional acts of said participant, including expenses incurred attendant thereto.

I, thereby request participation and grant permission for my child to participate fully in the CREW - Leaders For Mary Inc. programs and hereby give my permission to accompanying chaperones to supervise, care and discipline my child.

Further, should it be necessary for the participant to return home due to medical reason, disciplinary action or otherwise, I assume all transportation costs. I assume all liabilities for any personal injury, damage and expense incurred as a result of riding in or driving any vehicle to and from said activity.

I have read and agree to the above statements and to the standards of conduct for CREW - Leaders For Mary Inc.

I have read the foregoing statements above and understand the rules of conduct and will abide by them, as well as the directions of the leadership of its Directors and VIRTUS Trained Volunteer Adults of the CREW - Leaders For Mary Inc. I understand that my participation in said activities can be ended at any time at the discretion of the leadership of its Directors and VIRTUS Trained Volunteer Adults of the CREW - Leaders For Mary Inc.