Off Property Form Participants Name
Date of Birth
Street Address (St., City, Zip Code)
Parent/Guardian Name
Cell Phone Number(s) of those that can be reached in case of emergency
Important! To be filled out by the Parent/Guardian for youth under 18 years of age and individuals age 18 or older and in high school.
In consideration of the program in which my son/daughter will participate, I, as parent or guardian of my son/daughter, do hereby agree to allow my son/daughter to accompany Prince of Peace Catholic Church to:
Event/Location
Date/Time of event.
Transportation:
Method of Transportation
I acknowledge that Prince of Peace Catholic Church is providing transportation only from POP Parish to and from the event. I acknowledge and assume the risk of this transportation for my child. My child must comply with Prince of Peace Catholic Church rules and procedures. By granting this permission, I also waive any claims against, and RELEASE AND HOLD HARMLESS AND INDEMNIFY, Prince of Peace Catholic Church, The Diocese of Orlando, any of their religious, employees, volunteers, agents and representatives from any liability, claims, demands and causes of action arising out of or relating to any loss, damage or injury sustained in connection with or arising out of my child’s participation in the program.
Inputting your name below is the signature for this online form. Please type your name, signing and agreeing to the above statement.
Date Signed
Participant: In signing the line below, I agree to abide by any/all policies established for this event/activity. Should I not be able to maintain the guidelines and expectations of the adults and my peers, I understand there will be consequences for my actions, including being removed from the activity and being sent home at my parents/guardian’s expense.
Participant's Name (typing is a form of signature for this online form).
Date Signed
Insurance Information: Fill out the info below.
Do you carry insurance at this time?
Insurance Carrier
Name of Insured
Insurance Policy Number
In the event the participant does not have insurance, payment in full for medical care becomes the responsibility of the participant’s parent/guardian.
