1. I, the custodial parent/legal guardian of (the "Child" named above), give permission for my Child to participate in the activity described on the Activities Information Form (the "Activity") and release from all liability, indemnify, and hold harmless St. Maximilian Kolbe Parish, Liberty Township, OH (print name of parish and school) ("Parish and School"), the Archdiocese of Cincinnati (the "Archdiocese"), the Archbishop of Cincinnati (the "Archbishop"), both individually and as trustee for the Archdiocese, all parishes and schools within the Archdiocese, and all of their agents, representatives, volunteers, and employees from any and all liability, claims, judgments, damages, costs and expenses, including attorneys' fees, arising out of any injury, illness, infectious and/or communicable disease (such as MRSA, influenza, or COVID-19), or death, (including any injury, illness, infectious and/or communicable disease, or death caused by the negligence of Parish and School, the Archbishop, the Archdiocese, any parish or school within the Archdiocese, or any of their agents, representatives, volunteers, or employees) incurred by my Child while participating in the Activity, traveling to or from the Activity, or while using the facilities and equipment of the Parish and School. I further agree not to bring or prosecute or allow to be brought or prosecuted (including, but not limited to, prosecution through subrogation) in my name, or on behalf of my Child, any claims, lawsuits, or actions against Parish and School, the Archbishop, the Archdiocese, all parishes and schools within the Archdiocese, or their agents, representatives, volunteers, and employees.

2. I understand that my Child's participation in the Activity is purely voluntary and is a privilege and not a right, and that my Child, and I on behalf of my Child, agree to my Child's participation in the Activity in spite of the risks of injury, illness, infectious and/or communicable disease (such as MRSA, influenza, or COVID-19), and death. I agree that if my Child has underlying health concerns which may place him/her at greater risk of contracting COVID-19 or that would possibly increase the severity of illness if COVID-19 is contracted, then my Child and I will consult with a health care professional before participating in the Activity.

3. I agree to instruct my Child to cooperate with the agents of Parish and School and/or the Archdiocese who are in charge of the Activity.

4. I authorize the agents of Parish and School and/or the Archdiocese who are acting as leaders of the Activity to seek medical treatment for my Child in the event of any injury, illness, or medical emergency during the Activity or related travel. I understand that the agents of Parish and School and/or the Archdiocese will make a reasonable attempt to contact me as soon as possible in the event of a medical emergency involving my Child.

7. This Permission, Release, and Authorization is intended to be as broad and inclusive as permitted by the law of the State of Ohio, and if any portion hereof is declared invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This Permission, Release, and Authorization shall be construed in accordance with the laws of the State of Ohio, excluding, and irrespective of, any choice of law principles to the contrary.

8. Parish and School, the Archdiocese, the Archbishop and their agents, employees, and volunteers shall have no liability whatsoever in the event the Activity is cancelled due, in whole or in part, to any present or future pandemic, epidemic, widespread disease or illness, public health concern, or circumstances arising therefrom, or from actions taken by any governmental or municipal authority to prevent, avoid, or mitigate the impacts thereof.

I have carefully read and understand and accept the terms and conditions stated herein and I acknowledge and agree that this Permission, Release, and Authorization to Seek Medical Treatment shall be effective and binding upon me, my Child, and our personal representatives, estates, assigns, heirs, and next of kin. I have signed below of my own free will.

Completed by Custodial Parent/Legal Guardian — Please Print

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(See Activity Information Form below)

Completed by Parish/School -- Please Print

ACTIVITY INFORMATION- SUBJECT TO CHANGE Keep this page for your records!

Church Agency: St. Maximilian Kolbe Church Faith Formation /Usual Location:St. Maximilian Kolbe Catholic Church/Family Life Complex
Starting Date: June 1, 2026 / Ending Date: May 31, 2027

Program or Group Athletics
Usual day and time: As scheduled /Routine Activities: Practices, open gyms, and gamesGroup Leader: Robin Burbrink, 513-777-4322 Ext 124, rburbrink@saint-max.org

Program or Group
Usual day and time: Wednesday evenings 5:15-6:15 pm
Routine Activities: Weekly rehearsals and singing at Mass as announced
Group Leader: Jonathan Alexander, 513-777-4322 Ext 108, jalexander@saint-max.org

Program or Group Dead Theologians Society
Usual day and time: Second & Fourth Fridays of each month Sept.-May
Routine Activities: Formation for Grades 8-12
Group Leaders: Jo Zink, jzink@saint-max.org

Program or Group Fuel, Spark (Religious Formation for Youth)
Usual day and time: September-April, formation events as announced
Routine Activities: Family/Youth Formation
Group Leader: Mary Lou Baker, 513-777-4322 Ext 120, mbaker@saint-max.org

Program or Group Handbell Choir
Usual day and time: Monday evenings, Saturdays, Sundays, and as announced
Routine Activities: Weekly rehearsals and ringing at Mass as announced
Group Leader: Veronica Murphy, 937-620-7139, vurphy@hotmail.com

Program or Group Heavenly Heroes Summer Camp (HHSC) and Kamp Kolbe
Usual day and time: Summer Camp
Routine Activities:
Group Leader: HHSC: Jo Zink, 513-777-4322, Ext 139, jzink@saint-max.org; Roya Salehpour, 513-777-4322, Ext 118, rsalehpour@saint-max.org
Kamp Kolbe: Sarah Lewis, 513-777-4322, Ext. 128, slewis@saint-max.org

Program or Group High School Singers
Usual day and time: Saturdays 3:30 pm-5:30 pm (once/month), Sundays and occasional weeknights as announced.
Routine Activities: Rehearsals and singing at Mass as announced
Group Leader: Jonathan Alexander, 513-777-4322 Ext 108, jalexander@saint-max.org

Program or Group High School Youth Group Ablaze, Service Camp
Usual day and time: Ablaze (Gd. 9-12): Weekly on Sundays & as announced, some offsite events, 7:00-9:00 pm
Usual day and time: Service Camp: One week in summer as announced, 8:00am-12:00pm
Routine Activities: Comprehensive Youth Ministry for High School and Retreats
Group Leader: Roya Salehpour, 513-777-4322 Ext 118, rsalehpour@saint-max.org

Program or Group Jr. High Youth Group - Ignite, Service Camp
Usual day and time: Ignite (Gd. 7-8): Bi-weekly on Sundays & as announced, some offsite events, 4:30-6:00 pm
Usual day and time: Service Camp (Gd. 7-8): One week in summer as announced, 8:00am-12:00 pm
Routine Activities: Comprehensive Youth Ministry for Gd. 7-8 and Retreats
Group Leader: Roya Salehpour, 513-777-4322 Ext 118, rsalehpour@saint-max.org

Program or Group Middle School Youth Group - Ember
Usual day and time: Ember (Gd. 5-6): Bi-weekly on Sundays & as announced, 4:30-6:00 pm
Routine Activities: Comprehensive Youth Ministry for Gd. 5-6
Group Leader: Fr. Jim Riehle, 513-777-4322 Ext 102, jriehle@saint-max.org

Program or Group Mighty Max
Usual day and time: Mondays, Tuesdays, and Thursdays as scheduled
Routine Activities: Early Childhood Ministry
Group Leader Sarah Lewis, 513-777-4322 Ext 128, slewis@saint-max.org
Program or Group Sacramental Preparation for Confirmation
Usual day and time: Tuesday evenings as scheduled, Sunday afternoon Opening Event, Saturday retreat
Routine Activities: Formation Sessions and Retreats
Group Leader: Robin Burbrink, 513-777-4322 Ext 124, rburbrink@saint-max.org

Program or Group Sacramental Preparation for Penance and Eucharist
Usual day and time: Tuesday evenings and Saturday mornings as scheduled
Routine Activities: Formation Sessions and Retreats
Group Leader: Robin Burbrink, 513-777-4322 Ext 124, rburbrink@saint-max.org
Note - Additional information may be found on the parish web site. This may include schedules, lists of specific activities, parent handbook, etc. to
further inform parents(s) or guardian(s).