Youth 2000 Retreat Liability Release Form Release Of All Claims
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2YOUTH 2000 RETREAT LIABILITY RELEASE FORM
RELEASE OF ALL CLAIMS
***LIABILITY RELEASE FORM BELOW MUST BE COMPLETED & SIGNED FOR ALL PARTICIPANTS***
Name of Activity: YOUTH 2000 Retreat
Location: Nolan Catholic High School, 4501 Bridge St., Ft. Worth, TX 76103
Telephone: Registration: 817-560-3300 ext. 356
General Information: 817-558-9805
Date of Activity: April 1, 2, 3, 2016
Mail this form in your binder, along with all the other completed forms listed in the Registration Instructions to:
Divine Mercy Committee, 4433 Fair Ridge Dr., Aledo, TX. 76008
The undersigned do hereby release, forever discharge and agree to hold harmless YOUTH 2000, Inc., the
Diocese of Fort Worth, and Nolan Catholic High School from and against any and all liability, claims, demands, lawsuits
and expenses of any kind arising from personal injury, sickness, death or property damage of any kind whatsoever which
may be incurred or suffered by the undersigned and/or participant (if participant is under 18, 18 or older).
The undersigned further agree to indemnify and hold YOUTH 2000, Inc., the Diocese of Fort Worth and Nolan
Catholic High School and their respective members, directors, employees, and agents (collectively, the "Indemnities,")
harmless from and against any and all claims, demands, actions, lawsuits, and liabilities, including attorney fees and
expenses and costs sustained by the Indemnities as a result of negligent, willful or intentional acts of the undersigned
and/or participant (if participant is 18 or under, 18 or older).
If participant is under 18 years of age, I, the parent or legal guardian of the participant, do hereby grant
permission for my child to participate fully in the YOUTH 2000 Retreat and all of its activities. In the event that neither the
chaperone nor I can be reached, I hereby give permission to the agents of YOUTH 2000, the Diocese of Fort Worth and
Nolan Catholic High School to take said participant to a doctor or hospital and hereby authorize medical treatment,
including but not limited to emergency surgery and I fully and completely assume all responsibility for all medical bills.
Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or
otherwise, I assume all responsibility and transportation costs.
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This form MUST be signed by ALL participants.
If participant is under 18, parent or legal guardian must sign.
Name______________________________________________________Age______ Sex: Male
Female_____
Address ___________________________________City _____________________State ________Zip ___________
Telephone: Home ________________________Work _________________________Cell _____________________
Parish/Group __________________________Address ________________________________City ______________
Youth Leader's or Parent/Chaperone’s Name ________________________________Cell_______________________
Participant’s signature (if 18 or older) ____________________________________________Date______________
Parent or Legal Guardian Signature______________________________Cell__________________Date_________
EACH CHAPERONE and/or volunteer with youth must fulfill and be in compliance with their Diocesan policies
and requirements for providing a safe and secure environment for minors.
If you are from outside of the Fort Worth Diocese, please attach a compliance letter from your parish or diocese, to this
YOUTH 2000 Liability Release Form. A person may not vouch for themselves that they have complied. Note: Online
Renewal Certificate will not suffice
If you are registering with a parish/school/group, send this and all other forms to your parish/school/group
leader coordinating the group that will be attending the YOUTH 2000 retreat.
Each Parish/School/Group Leader acknowledges responsibility that all Fort Worth Diocesan Forms are signed,
filled out, and turned in as designated in the Registration Instructions.
NOTE: ANY PARTICIPANT UNDER 18 YEARS OF AGE MUST HAVE :
(1) A DESIGNATED LEADER/CHAPERONE (1 leader to 6 participants) and
(2) WRITTEN PERMISSION SIGNED BY A PARENT OR LEGAL GUARDIAN IF PLANNING TO LEAVE THE
RETREAT DURING RETREAT HOURS. (Chaperone must accompany minor with note to door monitor)
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