Trunk Or Treat Registration

Trunk Or Treat Registration

OCTOBER 18TH, 2025
Activity Participant Details:
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail
example@example.com
What theme will your car be decorated? *
Automobile Insurance Statement

Catholic Mutual Group
I understand that I am required to carry insurance coverage on any personal vehicle, which I might use in the course of conducting Parish/Diocesan business for ST. JOSEPH THE WORKER, LOMA LINDA, CA.

I further understand that I am required to have a valid driver’s license and proof of valid insurance in my possession while driving and that I am required to follow all California State Vehicle Codes while operating a motor vehicle on Parish/Diocesan business on nay street or highway, private or public roads, at all times. This includes using and requiring all passengers to use seat belts and child safety seats (as required by laws).

I further understand that I will properly maintain the vehicle, which I might use to transport parishioners/volunteers or staff members, in a safe mechanical condition (as required by law).

I understand and agree that I will provide ST. JOSEPH THE WORKER, LOMA LINDA with a copy of my valid driver’s license and valid insurance, and will provide updated copies when renewed or when validity, class or other information has changed. I understand that my auto liability limit will be $100,000/$300,000 per occurrence, for liability and property damage.

I also understand and agree that I will not drive any personal vehicle, which is uninsured on ST. JOSEPH THE WORKER, LOMA LINDA property or use it to transport parishioners/volunteers or staff members at any time.
Auto Insurance Information*

Insurance CarrierAuto Policy Number
Have you ever been convicted of any vehicle code violations with in the past three years?*

YesNo
If yes, please list the violation here and date.
Upload image of your Auto Insurance Card & Drivers License

Cancelof
Adult Hold Harmless/Indemnity Agreement

Catholic Mutual Group
The above named ACTIVIY PARTICIPANT agrees to defend, protect, indemnity and hold harmless ST. JOSEPH THE WORKER CHURCH against and from all claims arising from the negligence or fault of the above named ACTIVITY PARTICIPANT or any of their agents, family members, officers, volunteers, helpers, partners, organizational members or associates which arise out of THE FALL FESTIVAL at ST. JOSEPH THE WORKER CHURCH.

Additionally, ACTIVITY PARTICIAPNT agrees to defend, protect, fully indemnity and hold harmless ST. JOSEPH THE WORKER CHURCH for any claims or cause of action whatsoever arising out of the FALL FESTIVAL which takes place ON OCTOBER 18TH, 2025 that is brought against the PARISH by the above named ACTIVITY PARTICIPANT, or their family members whether such claim arises from the alleged negligence of the ST. JSOEPH THE WORKER CHURCH, it’s employees or agents or an ACTIVITY PARTICIPANT’S negligence. If any portion of this agreement is held invalid, it is agreed that the balance thereof, shall continue in the full legal force and effect.
By signing below I agree to all the above terms.
Signature*

Powered by Jotform SignClear
Should be Empty:

Trunk Or Treat Registration

Automobile Insurance Statement

Adult Hold Harmless/Indemnity Agreement