FAM Youth Disney Trip

PARTICIPANT INFORMATION

FIRST NAME*

LAST NAME*

Date of Birth*

MM slash DD slash YYYY

Allergies/Medications/or Special Needs (If NONE, write NONE)*

PARTICIPANT MOBILE PHONE*

PARTICIPANT EMAIL ADDRESS*

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Home Address

Home Address*

Street Address City State ZIP Code

Emergency Contact Information

Must be 18 Years or Older

Emergency Contact First Name*

Emergency Contact Last Name*

Relationship to Participant*

Emergency Contact Phone*

AGREEMENT TO FOLLOW DIRECTIONS*

I agree to observe and obey all posted rules and warnings, and further agree to follow any oral instructions or directions given by St. Peter's Chaldean Catholic Cathedral, its clergy, its volunteers and youth leaders, or the employees, representatives or agents of St. Peter's Chaldean Catholic Cathedral and the Chaldean Catholic Eparchy of St Peter the Apostle.

I agree to follow directions

MEDICAL CONSENT*

I understand that reasonable precautions will be taken to safeguard the health and wellbeing of the participants in this Trip and that myself or my emergency contact will be notified as soon as possible in the event of an emergency. In the case of sickness or an accident, and in the event that I am unable to consent to medical care on my own or other legal guardian(s) or emergency contact cannot be reached, I authorize and consent that the Trip Coordinators, or other associated volunteers of the Trip program to obtain medical care from a licensed physician, hospital, or medical clinic for myself or my child if needed. I hereby do release and forever discharge St Peters Chaldean Catholic Cathedral, The Chaldean Catholic Diocese of St Peter the Apostle, its clergy, officers, directors, board members, and volunteers from all manners of actions, claims, which I or the child(ren) named above shall or may have for any reason, arising during attendance and participation of the Trip.

I agree to the Trip Terms and Conditions

ASSUMPTION OF THE RISKS AND RELEASE*

I recognize that there are certain inherent risks associated with the above described activity and I assume full responsibility for personal injury to myself and (if applicable) my family members, and further release and discharge St. Peter's Chaldean Catholic Diocese for injury, loss or damage arising out of my or my family's use of or presence upon the facilities of St. Peter's Chaldean Catholic Diocese, whether caused by the fault of myself, my family, St. Peter's Chaldean Catholic Diocese or other third parties.

I understand the risks and release

INDEMNIFICATION and GOVERNING LAW*

I agree to indemnify and defend Chaldean Catholic Diocese of St Peter the Apostle against all claims, causes of action, damages, judgments, costs or expenses, including attorney fees and other litigation costs, which may in any way arise from my or my family's use of or presence upon the facilities of Chaldean Catholic Diocese of St Peter the Apostle. Any legal or equitable claim that may arise from participation in the above shall be resolved under California law.

I Agree

NO DURESS*

I agree and acknowledge that I am under no pressure or duress to sign this Agreement and that I have been given a reasonable opportunity to review it before signing. I further agree and acknowledge that I am free to have my own legal counsel review this Agreement if I so desire.

I agree

ELECTRONIC COMMUNICATION AND PHOTOGRAPHY*

I consent to receive communication with via mobile phone, sms/mms messages, e-mail and any kind of online communications/applications. I understand and consent to allowing my image or child’s image to be recorded, either by photograph or video, and used during the Trip and/or posted digitally online web/social media/live stream and or future print material.

I consent to Receive Electronic Communication and Photography

DISNEY CALIFORNIA ADVENTURES TICKET*

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