Permission Form and Liability Waiver

I, (your name)*

First NameLast Name

, the parent/guardian of (child's name)*

First NameLast Name

give permission for my child to attend the (name of event)*

I understand that personal injury can and may occur to my child, and I hereby authorize Name and Title of Person Responsible Here, or another appointed youth advisor, to seek and consent to emergency medical attention for my child as needed; and I further agree to be liable for and to pay all costs incurred in connection with such medical attention.

I hereby release St Nicholas Cathedral, its employees, agents and volunteers, from any and all liability, claims, demands, causes of action and possible causes of action whatsoever arising out of or related to any loss, damage or injury (including death) that may be sustained by my child while participating in or traveling to and from this event.

The following is all of the insurance information, restrictions, allergy and medication information necessary for my child to receive appropriate medical care:

I give permission for my child to ride in any vehicle designated by St. Nicholas Cathedral, its employees and adult volunteers, while participating in and traveling to and from this event.

I agree to accept full responsibility, financially or otherwise, for any damage my child may do to the property of St. Nicholas Cathedral, properties visited on outing, other’s personal property, or vehicles used for transportation.

Community Standards
In accordance with the Orthodox Church in America, Archdiocese of Washington, the following behavior will not be tolerated at any St. Nicholas Cathedral children/youth gathering. Violation of these standards, or being knowingly in the presence of others violating these standards, can and will result in consequences deemed appropriate by the clergy, employees, volunteers , and advisors of St. Nicholas Cathedral, including, but not limited to, being sent home immediately at the participant’s expense.
*Possession or use of alcohol, tobacco, or illegal drugs.
*Possession or use of weapons, including pocket knives, firearms, and fireworks.
*Inappropriate sexual behavior.

Signature*

Date of Signature*

Date

Phone Number*

Area CodePhone Number

E-mail*

Saint Nicholas Cathedral operates solely on the charitable donations of its parishioners. Please consider donating so we may bring more and better activities for our Sunday School youth. Your donations are tax deductible so please consider giving generously to help improve our Sunday School. Our children are our future and we consider ministering to them as an investment in their, as well as our, future.

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