Edge SOULStice Registration 2022
The registration info/liability release required to go on the SOULstice retreat
Sign in to Google to save your progress. Learn more
Email *
Youth's Name (First and Last) *
Youth's Grade (as of Fall 2022) *
Youth's Age *
Youth's Gender *
Parent/Guardian Name (First and Last) *
Home Address *
City *
Zip *
Parent/Guardian Cell *
Emergency Contact (Other Than A Parent) *
Emergency Contact Relationship to Youth (grandmother, family friend, etc.) *
Emergency Contact Phone Number *
Health Insurance Company *
Policy Number *
Name of Youth's Doctor *
Youth's Doctor's Phone *
Other medical or otherwise pertinent information
I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend St. Lawrence, its officers, directors, employees and agents, and the Archdiocese of Mobile, its employees and agents, chaperones, or representatives associated with "SOULstice", from any claim arising from or in connection with my child attending "SOULstice" or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the parish/school/institution, its officers, directors and agents, and the Archdiocese of Mobile, its employees and agents and chaperones, or representative associated with the event for reasonable attorney’s fees and expenses that may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the parish/school/institution/archdiocese. IN ADDITION, by signing this agreement, I acknowledge the contagious nature of COVID-19 and that my child(ren) and I may be exposed to or infected by COVID-19 by participating in the St. Lawrence activity and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at St. Lawrence may result from the actions, omissions, or negligence of myself and others, including, but not limited to, St. Lawrence employees, volunteers, and program participants and their families. Considering the foregoing, however, I grant permission for my child(ren) to participate in this parish activity taking place off-campus, notwithstanding the risks associated with the COVID-19 virus and group activities. I further agree on behalf of myself, my child named herein, and my spouse, our heirs, successors, and assigns, to release, indemnify, and hold harmless St. Lawrence and The Roman Catholic Church of the Archdiocese of Mobile, their members, directors, officers, employees, agents and representatives (“Indemnitees”) associated with the event arising from or in connection with the negligent acts or omissions of the Indemnitees ONLY in regard to prevention of the spread of the COVID-19 virus. I SPECIFICALLY ACKNOWLEDGE AND AGREE TO THE FOREGOING. *
A copy of your responses will be emailed to the address you provided.
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy