Spring Service Day Sign-up Sheet
Help our parishioners with yard and housework! Lots of volunteers are needed for the upcoming Spring Work Day on Saturday, April 21st from 10am-2pm. Thank you in advance for your help - we couldn't make this event happen without you!
First Name: *
Your answer
Last Name: *
Your answer
Phone Number: *
Your answer
E-mail Address: *
Your answer
Do you have a car on-campus and are able to help drive? *
If you answered yes, how many other students are you able to drive? *
Your answer
Archdiocese of Cincinnati Adult Permission, Medical Release and Power of Attorney Title
1. I, the undersigned will participate in the activity described on this registration form and release from all liability and indemnify the Archbishop of Cincinnati (the Archbishop), both individually and as trustee for the Archdiocese of Cincinnati and all parishes and schools within the Archdiocese (the Archdiocese), and their officers, agents, representatives, volunteers, and employees from any and all liability, claims, judgments, cost and expenses, including attorney's fees, arising out of any injury or illness incurred by me while participating in or traveling to or from the activity and further agree not to bring or prosecute or allow to be brought or prosecuted (including but not limited to prosecution through subrogation) in my name, any claims, lawsuits or actions against the Archbishop, the Archdiocese, and their officers, agents, representatives, volunteers and employees.

2. I further understand that my participation is purely voluntary and is a privilege and not a right. I elect to participate in spite of the risks.

3. I agree to cooperate with the Archbishop or his agents in charge of the activity.

4. I appoint the Archbishop or his agents who are acting as leaders of the activity as my attorney in fact to act for me in my name and my behalf, in any way that I would act if I were personally present, with respect to the following matters if any injury, illness or medical emergency occurs during the activity or related travel:

5. To give any and all consents and authorizations to any physicians, dentist, hospital or other persons or institutions pertaining to any emergency medications, medical or dental treatments, diagnostic or surgical procedures or any other emergency actions as our attorney shall deem necessary or appropriate for my best interest.

6. This power of attorney shall lapse automatically upon completion of the activity and related travel.

7. I agree that the Archbishop or his agents may use my portrait or photograph for promotional purposes, website and office functions.

8. This acknowledgement and release is intended to be as broad and inclusive as permitted by the law of the State of Ohio, and if any portion hereof is declared invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This acknowledgement and release shall be construed in accordance with the laws of the State of Ohio, except for the choice of law provisions thereof.

I have carefully read and understand and accept the terms and conditions stated herein and acknowledge that this Permission, Release and Medical Power of Attorney shall be effective and binding upon me and my own personal representative or estate, assigns, heirs, and next of kin and that I have signed this agreement of my own free will.

Please check "I Agree" to indicate you have read and understand the above permission form: *
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