TEC Parents Permission
Welcome to online TEC Parent Permission Form. Your minor child has accepted an opportunity to participate on an upcoming TEC Weekend. Your permission is necessary for teen's under the age of 18 years old.

We believe that TEC is a great experience for every adolescent and an opportunity to continue to grow in their faith life and come to understand, reflect upon, and share their ideas and ideals with other teens in a nonthreatening environment. We hope that you agree!

Please read the terms and conditions of participation carefully. Acknowledgement and your acceptance of these conditions is required by the Catholic Diocese of Peoria. You will indicate your concurrence by entering your full typed Name, which will represent your signature.

IF YOU HAVE ANY QUESTIONS OR CONCERNS,
PLEASE CONTACT Tod Williamson, at 309-825-1162, or email bloomingtontec@gmail.com

Your Son or Daughters Name *
Your answer
TEC Number *
TEC numbers can be found on the Registration Webpage
Your relationship to the Participant *
Does this child live with you? *
If NO above,Your Current Mailing Address
Your answer
Part One: Permission Statement and Waivers
I grant permission for my minor child, to participate in Bloomington/Normal Teens Encounter Christ (B/N TEC). This activity will take place under the guidance and direction of B/N TEC volunteers. I understand the risks such activity presents to my child, including, but not limited to serious personal injury or death. Any questions I have concerning this activity have been answered.

As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor ("participant"). In consideration for my child being allowed to participate in this activity, I hereby RELEASE AND AGREE TO INDEMNIFY AND HOLD HARMLESS the Bloomington/Normal TEC, the Catholic Diocese of Peoria, their employees and agents, and any volunteers assisting B/N TEC, from any and all liability for injuries, damages, medical expenses, or any other loss to my child or family or me (including attorneys' fees) arising from or related to my child's participation in this activity.

On occasion, B/N TEC may take photographs or makes audio or video tape recording of participants involved in activities. Such photographs or video records may be used by staff and participants to remember the activities or participants. In addition, such photographs and audio/visual recordings may be used by B/N TEC publications or advertising materials to let others know about B/N TEC. In addition, local news organizations may hear of our activities or event, and B/N TEC may invite or allow them to photograph or record our events to be used, distributed, or displayed as agents of B/N TEC see fit. This consent includes but is not limited to photographs, videotape, and audio recordings.

Do you understand and accept the conditions and waivers as stated above? *
Note: a negative response will disqualify your child from TEC participation.
For your information, your child has read and accepted the follow regarding personal conduct:
As a participant in B/N TEC, I promise to conduct myself in accordance with the regulations on conduct as set forth by B/N TEC. I understand that B/N TEC, the Catholic Diocese of Peoria, its officers, agents, and/or employees reserve the right to terminate my participation in the B/N TEC for failure to behave and act in accordance with the regulations of conduct, for failure to follow instructions and directions of the adult leaders or chaperones, or for any of my acts of conduct that are deemed by B/N TEC, its officers, agents, or employees to be detrimental to or incompatible with the interest, harmony, comfort, or welfare of the activity as a whole. If my participation is terminated, only funds not actually used will be refunded, and I will leave immediately, if asked to do so, at my own expense. I agree that B/N TEC, its officers, agents, or employees reserve the right at any time prior to or during the activity to make cancellations, changes, or substitutions in emergencies or in the interest of the participants.
Have you reviewed and understand the policy regarding "participants"conduct? *
Part Two: Emergency Contact and Medical Information
This section has two purposes:

1. to provide primary and secondary emergency contacts and general medical health information, and;
2. to produce a standard authorization for Emergency Medical Treatment (Attachment A)

Providing this information will make adult leaders aware of any conditions that might affect participation and identify those who may need to take medications during the TEC weekend. It may also assist the TEC Leadership or qualified medical professionals in determining the proper actions in treatment of your child if an emergency should arise.

PRIMARY EMERGENCY CONTACT PERSON *
This should be a parent/guardian that will be available to be contacted throughout the TEC Weekend!
Your answer
PRIMARY CONTACT NUMBER *
(999) 999-9999
Your answer
Allergies or Allergic Reactions:
Please list any applicable and level of severity
Your answer
Medical Facility Preference
Your answer
Authorization for Emergency Medical Treatment for an Overnight Activity
I, [ the parent/guardian ], understand that in the case of illness of my child, [the participant.], that Bloomington/Normal Teens Encounter Christ (B/N TEC) will attempt to notify me or the person(s) I have listed below as emergency contacts.

In case of a medical emergency concerning my child, at a time when I or my listed emergency contacts cannot be reached, I grant full power to B/N TEC and/or any supervising employee to do as follows:
1.) Arrange for the transportation of my child, whether by ambulance or otherwise, to a proper facility where emergency medical treatment would normally be administered, including but not limited to, an emergency room of a hospital, a doctor's office, or a medical clinic; and;
2.) Sign releases as may be required in order to obtain any medical or surgical treatment as is required in the judgment of competent medical authorities at the facility.

Signature *
By entering my FULL Name [representing my(our) signature(s)], I am declaring that I/we accept the conditions as stated above, and that the information I provided above is true and accurate to the best of my knowledge.
Your answer
Spouses Full Name, if applicable.
Your answer
PHONE NUMBER *
Where you can best be contacted, if necessary.
Your answer
Freewill Contribution (toward weekend costs.)
The recommended contribution for team members, and or candidates, $75. This helps defray the cost of meals and facilities. Make checks payable to "B/N TEC." [Please include team members name and TEC number] You can send the check with your teen for the weekend too.
Team Contributions
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