Liability and Waiver – Medjugorje, 2022

- Register/Donate

The maximum number of form submissions has been reached. This form is currently not available.
- Liability Waiver & Medical Authorization Form
  Parish of Saint Thomas the Apostle Millis, Massachusetts
- Acknowledgement and Assumption of Risk
  
  The undersigned participant, parent and/or legal guardian, does hereby acknowledge that I am or he/she is aware of the dangers and risks to person and property by participating in:
  
  Medjugorje Pilgrimage 2022
  
  Dates: Sunday July 31st - Tuesday August 9th
  
  Cost: $2,400 (or less if you're a teen) – includes everything - stay, flights, food, transportation
  
  Description: Our trip to Medjugorje is considered a pilgrimage, which makes you a pilgrim. A pilgrim is one who travels to a sacred place for the purpose of venerating it or to ask for heavenly aid, and ultimately to come to know God better. This means that a pilgrim practices his or her faith regularly.
  
  Nevertheless, I, or the undersigned parent and/or legal guardian, voluntarily elect to participate in this activity with knowledge of the danger involved, and hereby agree to accept and assume any and all risk of property damage, personal injury, or death.
- Medical Authorization, Indemnification and Waiver of Liability
  
  In consideration for being allowed to voluntarily participate in the above-referenced event, I hereby:
  
  a.) Consent to receive medical treatment, which may be deemed advisable in the event of injury, accident or illness during this activity or event. This release, indemnification, and waiver shall be construed broadly to provide a release, indemnification, and waiver to the maximum extent permissible under applicable law;
  
  b.) Agree to defend, indemnify, and hold harmless the Parish of Saint Thomas the Apostle along with the Roman Catholic Archbishop of Boston, a Corporate Sole, and its agencies, officers, and employees from and against any and all claims of any nature including all costs, expense and attorneys’ fees, which in any manner result from actions during this activity or event; and
  
  c.) Waive and release forever the Parish of Saint Thomas the Apostle along with the Roman Catholic Archbishop of Boston, a Corporate Sole, and its agencies, officers, and employees from any and all liability for death, disability, personal injury, property damages, property theft, or claims of any nature which may hereafter accrue as a direct or indirect result of the participation in the activity or event.
  
  Further, I affirm that I am at least 18 years of age and am freely signing this agreement. I have read this form and fully understand that by signing this form I am giving up legal rights and/or remedies that may otherwise be available regarding any losses sustained as a result of participating. I agree that if any portion is held invalid, the remainder will continue in full legal force and effect.
- Name of Participant
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age: Check if 18 or over. (optional) I am 18 or older
  
  Age, if under 18
  
  Electronic Signature Acknowledgement
  I have read and acknowledged the above information Please select this field.
  
  I understand that checking this box constitutes a legal signature confirming that I have read and understand the above and acknowledge and warrant the truthfulness of the information provided in this document.
- Printed Name of Participant
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Participant Cell Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Insurance Carrier Name REQUIRED Please fill out this field. Please enter valid data.
  
  Policy Number REQUIRED Please fill out this field. Please enter valid data.
  
  Important Medical Information about Participant (allergies, etc.)
- Printed Name of Parent/Guardian
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Cell Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
- Emergency Contact (Other than Parent/Guardian)
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact Cell Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Submit

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Liability and Waiver – Medjugorje, 2022

Acknowledgement and Assumption of Risk The undersigned participant, parent and/or legal guardian, does hereby acknowledge that I am or he/she is aware of the dangers and risks to person and property by participating in:

Medical Authorization, Indemnification and Waiver of Liability In consideration for being allowed to voluntarily participate in the above-referenced event, I hereby:

Acknowledgement and Assumption of Risk

The undersigned participant, parent and/or legal guardian, does hereby acknowledge that I am or he/she is aware of the dangers and risks to person and property by participating in:

Medical Authorization, Indemnification and Waiver of Liability

In consideration for being allowed to voluntarily participate in the above-referenced event, I hereby: