Steubenville Youth Conference Individual Registration Form

Parental Consent
I hereby consent to participation by my child, above named, in the Catholic Youth Conference. I understand that
my child will be under the supervision of designated parish staff/adult volunteers on the stated date. I further conu0002sent to the conditions stated in the event description regarding participation in this event, including the method of
transportation.
Further, I hereby authorize treatment for my child by a qualified and licensed physician of any condition which,
in the opinion of the physician, is deemed necessary and appropriate. This authority is granted only after a reau0002sonable effort has been made to reach me/my family. I further authorize the person who presents the minor to
sign the Acknowledgment of Receipt of Notice Privacy Rights that may be presented by the physician or health
care facility.
In consideration of my child being allowed to participate in the Steubenville Youth Conference, I agree to indemu0002nify and hold harmless and defend the Parish, any and all affiliated organizations, their employees, agents,
and representatives, including volunteers and other drivers, from any and all claims arising from or relating to my
child’s participation in this event. This indemnification and hold harmless and defense agreement does not apply
to claims for intentional misconduct.
Finally, I hereby give permission do not grant permission — for my child to be to photographed and/or
videotaped for promotion (website, brochures. Newsletters, etc.) of Parish programs.