22-11-2024 CTK Mission Youth

Hamilton Mission Youth

November 22-24

Christ the King

Music Missions

Minors Registration

Use this form if you are UNDER 18 years of age.

First Name*

Last Name*

Date of Birth*

Grade in School*

Gender*

Missionary's Email Address*

example@example.com

Missionary's Phone Number*

T-shirt size*

I'd like to read all the terms and conditions.

NATURE AND DURATION OF ACTIVITIES: Missions in Oakville, Ontario. Activities include street evangelization, serving the homeless on the street, times of prayer and formation, Mass and adoration. Missions are from 5pm on November 22 to 5pm on November 24, 2024.

ACTIVITY SUPERVISOR: Fr Adam Zettel, LC, Patti Birk

TRANSPORTATION: Participants are responsible for arriving at the correct locations at the start and end of the mission. Transportation is not provided throughout the mission, but carpooling is allowed and encouraged.

MENTORING: Participants may be offered mentoring, which is intended to help young people personalize the principles of Christian living that they receive at home and in retreat activities. Mentoring involves a private conversation with an adult conducted in plain view of others. When dealing with adolescents, confidentiality will be maintained to foster openness of dialogue, but situations involving sexual abuse of a minor or threats to life or physical health will be reported to the appropriate authority and to the parents (except in those cases where the parent may be the alleged abuser).

REQUIREMENTS: The child named above is in good health and has no physical or medical limitations that would cause the activities as described above to be detrimental or dangerous to the child. Parents/guardians should specify allergies and medical problems in section 9 below.

CONSENT: I/We hereby consent to the above-named child’s participation in the activities described above, and specifically request that he be allowed to participate in those activities. I/We warrant that I/We have full authority to legally consent to his participation in the activities described on this form, and all provisions contained herein.

AUTHORIZATION: I/We hereby authorize Legion of Christ Canada, Inc. to use the image and likeness of my/our child in photograph or video form whether taken by or commissioned by Legion of Christ Canada, Inc. in its promotional materials and for its promotional purposes associated with its nonprofit activities. This authorization shall extend to use of my/our child’s image and likeness on the website of Legion of Christ Canada, Inc. or its successor in operation or affiliated organization(s) upon written consent of Legion of Christ Canada, Inc. I/We understand that this authorization shall survive the end of my/our child’s participation in the activities referenced on this form.

INSURANCE: I/We understand that Legion of Christ Canada, Inc. does not carry any health insurance relative to the activities or for any injury that may occur to the above-named child. I/We represent that the child is (a) covered by insurance through my/our own insurance carrier; or (b) that I/We am/are personally financially responsible for any and all medical costs incurred as a result of the child’s injury.

EMERGENCIES: If the above-named child requires any emergency medical procedures or treatments during the activities, I/We consent to the activity supervisor(s) taking, arranging for or consenting to such procedures or treatments in the discretion of the activity supervisor(s). For purposes of such procedures and treatments, my/our child’s blood type allergies or other medical problems (if any) are listed below:

EMERGENCY CONTACTS: If, in the event of a medical or other emergency, I/We am/are unable to be reached by telephone at the numbers listed below, I/We authorize the activity supervisor(s) to attempt to contact me/us through the alternative emergency contacts listed below.

Allergies/Medical Issues*

Emergency Contact 1 (EMC 1 -The non-signing parent or other)*

First NameLast Name

Relation of EMC 1*

Phone Number of EMC 1*

Area CodePhone Number

RELEASE AND INDEMNIFICATION: I/We release and waive, and further agree to indemnify, hold harmless or reimburse Legion of Christ Canada, Inc. the individual members, agents, directors, officers, employees, volunteers and representatives thereof, as well as activity supervisors, from and against, any claim which I, any other parent or guardian, any sibling, the above-named child, or any other person, firm or corporation may have or claim to have, known or unknown, directly or indirectly, for any losses (including attorneys’ fees incurred by Legion of Christ Canada, Inc. or any of its individual employees, agents, volunteers, etc. in enforcing this indemnity provision) without limitation in time or amount, damages or injuries arising out of, during, or in connection with my/our child's participation in the activities, the travel to and there from, and the rendering of emergency medical procedures or treatment, if any. I/We understand that this release and indemnification shall survive the end of my/our child’s participation in the activities referenced on this form.

I/We have read and understand the above and agree to all terms and conditions contained therein.*

Yes

Date of Permission*

Date

Signing Parent's Name*

First NameLast Name

Signing Parent's Phone Number*

Area CodePhone Number

Signing Parent's Email Address*

example@example.com

Signature*

Waiver