MEDIA RELEASE AND CONSENT

I hereby give Certain Place Ministries, Inc. (“CPM”) and St. Patrick Church/St. Vincent Martyr Church/Pius X Church (the “Church;” together with CPM, the "Work Week Group”), and their licensees, including organizers and sponsors of events in which the Work Week Group participate, the right to photograph, film, record, document or capture, my name, image, voice, statements, and likeness (collectively "Likeness").  I further consent to the use, reuse, reproduction, license, display, and publication of such Likeness without restriction, in any and all media now known or hereafter devised throughout the universe in perpetuity for any purpose whatsoever in connection with the promotion of CPM, the Church, and Appalachia work weeks and their licensees, including without limitation any commercial or noncommercial use on websites, social media, news or advertising.  I understand that my Likeness may be combined with other images, videos, text, and/or graphics and may be cropped, altered, or modified. I hereby hold the Work Week Group and their licensees harmless and forever waive and release any claims against the Work Week Group and their licensees based on any rights of privacy, publicity, defamation, copyright infringement, or any other right that may arise from or be related to the use, exhibition, license, modification, distribution, publication, or reproduction of my Likeness. I understand that no compensation will be provided to me for or in connection with any use of my Likeness.  I represent and warrant that I am at least 18 years of age and able to provide this consent.

Activity/Event: The Appalachia Help Week (the “Activity”)

Date of Activity/Event: June 27 - July 26, 2025

Location of Activity/Event: VFW, Rowlesburg, WV and the surrounding county

Transportation:  I understand and acknowledge that transportation arrangements to and from the VFW in Rowlesburg, WV and throughout Preston County during the week of service are my responsibility whether I travel in my own personal vehicle or with another individual(s). I additionally understand and acknowledge that in the event that I travel in my own personal vehicle or with another individual, I agree that I am responsible for my own acts and for the safety and security of my own vehicle.  I accept full responsibility for the liability of myself and my passengers, and I understand that if I am a passenger in a private vehicle, Certain Place Ministries, Inc. is not in any way responsible for the safety of such transportation.  I further agree that Certain Place Ministries' insurance does not cover any damage or injury suffered in the course of traveling in a private vehicle.

Assumption of Risks: I understand that participation in this Activity carries with it certain risks and hazards directly or inherently involved that cannot be eliminated regardless of the care taken to avoid injuries: The risks include but are not limited to: 1) minor injuries such as scratches, bruises, and sprains; and 2) major injuries such as joint or back injuries, broken bones, head injuries, severe physical trauma, heart attack and stroke; or 3) other potential risks of loss of limb, property or life.  I also understand and recognize that there are risks and hazards directly or inherently involved in travel to and from this Activity and while participating in this Activity, and I expressly assume those risks.  With full knowledge of the facts and circumstances surrounding this Activity, I voluntarily undertake this Activity and assume all responsibility and risk associated with my participation in this Activity, including all risk of injury, property damage, injury to others, and other hazards to me. 

Waiver: In consideration of my voluntary participation in this Activity/Event and whether or not I travel to and from this Activity in my own personal vehicle, or whether I travel with another individual(s), I for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge, and agree to hold harmless CERTAIN PLACE MINISTRIES, INC.; its trustees, officers, agents, employees, volunteers and those for whom CERTAIN PLACE MINISTRIES may be held responsible, from any and all claims of liability for personal injury, accident, illness or death, and property loss arising from my participation in this Activity.  I willingly participate in this Activity and I assume any and all associated risks.

Assurances:  I assure officials of Certain Place Ministries, Inc. that I have adequate health insurance necessary to provide for and pay any medical costs that may directly or indirectly result from my participation in this Activity.   I further assure that there are no health-related reasons which preclude or restrict my participation.

Code of Conduct: I acknowledge that during the course of this trip, I am bound by the rules contained in the Appalachia Help Weeks list of rules and by the Diocese of Paterson compliance form. 

INDEMNIFICATION:  I AGREE TO INDEMNIFY AND HOLD HARMLESS CERTAIN PLACE MINISTRIES, INC., ITS  TRUSTEES, OFFICERS, DIRECTORS, AGENTS, EMPLOYEES, VOLUNTEERS AND THOSE FOR WHOM THE CERTAIN PLACE MINISTRIES MAY BE HELD RESPONSIBLE FROM AND AGAINST ALL CLAIMS, ACTIONS, SUITS, PROCEDURES, COSTS, EXPENSES, DAMAGES AND LIABILITIES, INCLUDING ATTORNEY’S FEES BROUGHT AS A RESULT OF MY INVOLVEMENT AND PARTICIPATION IN THIS ACTIVITY  INCLUDING BUT NOT LIMITED TO, ANY DAMAGE TO MY PROPERTY OR THE PROPERTY OF OTHERS AND INJURY TO ME OR TO OTHERS, INCLUDING LOSS OF LIMB OR LIFE, ARISING OUT OF MY PARTICIPATION IN THIS ACTIVITY.

Severability: The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the laws of the states of New Jersey, West Virginia and Arizona and that if any portion of it is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

Acknowledgement of Understanding:  I have read this waiver of liability, assumption of risk, release and indemnity agreement, fully understand its terms, and understand that I am assuming all risks associated with this Activity/Event and giving up substantial rights.  I recognize that this Release means that I am giving up the right to sue CERTAIN PLACE MINISTRIES, INC., its trustees, officers, agents, employees, volunteers, and those for whom CERTAIN PLACE MINISTRIES may be held responsible, for injuries or losses I may incur, and I understand this Release binds my heirs, executors, administrators and assigns, as well as me.  I acknowledge that I am at least 18 years of age and am signing this document freely and voluntarily and intend by my signature to completely and unconditionally release the above-named parties of all liability to the greatest extent allowed by law.

Adult Registration Fee:

$300 for St. Patrick & St. Vincent volunteers

$800 for Pius X volunteers ($300 deposit)

The registration fee for St. Patrick and St. Vincent adults is $300 with the expectation that each individual volunteer raise at least $500 apiece toward the cause. 

The fee for Pius X adults is $800 with no expectation to personally raise funds (although it would be welcome!)

Your registration will not be accepted until we receive your registration fee.  You will receive an email with a link to the online Registration fee payment page once this registration is submitted.  Or you can use the link provided on the Appalachia Registration page from the main website.

All who will be 18 years old or older by July 1, 2025 must be in full compliance with Diocesan Safe Environment Guidlines in order to participate in the Appalachia Help Weeks.

In order to ensure our children are in a safe environment our Diocese requires the following safe environment compliance procedures be followed before our volunteers are allowed to work with teens:

·         Complete an online background check through Selection.com known as Fastrax

·         Read, understand and acknowledge a Pastoral Code of Conduct

·         Attend a 3 hour Virtus live training  program entitled “Protecting God’s Children”  within the next 30 days

If you have already done these three things, you do not need to do anything else other than finish this form, submit it and pay the registration fee!

If you have not done these things, you must complete by June 1, 2025.   Instructions will be sent to you via email upon completion of this registration.