Confirmation Retreat

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Event Name
Participant Name Participant Name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Date of Birth Date of Birth / MM / DD YYYY
Youth Email
Parent Name Parent Name First Last
Parent Email
Primary Phone Primary Phone - ### - ### ####
Emergency Phone Emergency Phone - ### - ### ####
Permission to Participate
I grant permission for my son/daughter to participate in this parish youth ministry event, that requires transportation to a location away from the parish site. This activity will take place under the guidance and direction of Parish employees and/or volunteers from Saint Clare of Assisi.
Hold Harmless Agreement
As parent/legal guardian, I remain legally responsible for any personal actions taken by my son/daughter named above. I agree on behalf of myself, my son/daughter named herein, our heirs, successors, and assigns to hold harmless and defend Saint Clare of Assisi; including all its officers, directors, agents, and the Diocese of Charleston, from any liability for illness, injury or death arising from or in connection with my son's/daughter's attending the above named activity/event.
I give permission for my child, named above, to be photographed at this event and understand that the photographs may be used for publicity, etc...

I give permission for my child, named above, to be photographed at this event and understand that the photographs may be used for publicity, etc... Yes No
Draw your signature into the box below to grant permission and agree to hold harmless as stated in the paragraphs above.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.