Permission to Participate in Holy Week Missions
2020 RC Activities, Inc.
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    April 8-11, 2020: Youth and chaperones will be doing missionary activities (street missions, bringing food to the homeless, visiting the sick), participating in talks and team dynamics,and participating in the liturgical celebrations in local churches.

    Legionaries of Christ, Consecrated women of Regnum Christi, and other adult chaperones.

    Transportation by bus company and shorter commutes by private vehicles.

    Participants may be offered mentoring, which is intended to help young people personalize the principles of Christian living that they receive at home and in club activities. Mentoring involves a private conversation with an adult conducted in plain view of others. When dealing with adolescents, confidentiality will be maintained to foster an openness of dialogue, but situations involving sexual abuse of a minor or threats to life or physical health will be reported to the appropriate authority and to the parents (except in those cases where the parent may be the alleged abuser).

    The child named above is in good health and has no physical or medical limitations that would cause the activities as described above to be detrimental or dangerous to the child. Parents/guardians should specify allergies and medical problems in section 10 below.
  • 7. CONSENT

    I/We hereby consent to the above-named child's participation in the activities described above including mentoring, and specifically request that he be allowed to participate in those activities. I/We warrant that I/We have full authority to legally consent to his participation in the activities described on this form, and all provisions contained herein.

    I/We hereby authorize RC Activities, Inc. to use the image and likeness of my/our child in photograph or video form whether taken by or commissioned by RC Activities, Inc. in its promotional materials and for its promotional purposes associated with its nonprofit activities. This authorization shall extend to use of my/our child’s image and likeness on the website of RC Activities, Inc., or its successor in operation or affiliated organization(s) upon written consent of RC Activities, Inc. I/We understand that this authorization shall survive the end of my/our child’s participation in the activities referenced on this form.

    I/We understand that RC Activities, Inc. does not carry any health insurance relative to the activities or for any injury that may occur to the above-named child. I/We represent that the child is (a) covered by insurance through my/our own insurance carrier; or (b) that I/We am/are personally financially responsible for any and all medical costs incurred as a result of the child's injury.

    If the above-named child requires any emergency medical procedures or treatments during the activities, I/We consent to the activity supervisor(s) taking, arranging for or consenting to such procedures or treatments in the discretion of the activity supervisor(s). For purposes of such procedures and treatments, my/our child's blood type allergies or other medical problems (if any) are listed below:

    If, in the event of a medical or other emergency, I/We am/are unable to be reached by telephone at the numbers listed below, I/We authorize the activity supervisor(s) to attempt to contact me/us through the alternative emergency contacts listed below.
  • Parent/Guardians Contact Information

  • Email address
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    Alternate Phone
  • Email address
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    Home Phone
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    Alternate Phone
  • Alternative Emergency Contact Information

  • Relation
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    Alternate Phone

    I give permission for Event Supervisor(s) and Club Leader(s) to communicate with my child using text messaging and/or email regarding the details of the Activity / Program (*Only participants 15 years old and older*).
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    Child's cell
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    Parent's cell
  • Child's email
  • Parent's email

    I/We release and waive, and further agree to indemnify, hold harmless or reimburse RC Activities, Inc. and Consolidated Catholic Administrative Services, Inc., the individual members, agents, directors, officers, employees, volunteers and representatives thereof, as well as activity supervisors, from and against, any claim which I, any other parent or guardian, any sibling, the above-named child, or any other person, firm or corporation may have or claim to have, known or unknown, directly or indirectly, for any losses (including attorneys’ fees incurred by RC Activities, Inc. and Consolidated Catholic Administrative Services, Inc., or any of its individual employees, agents, volunteers, etc. in enforcing this indemnity provision) without limitation in time or amount, damages or injuries arising out of, during, or in connection with my/our child's participation in the activities, the travel to and there from, and the rendering of emergency medical procedures or treatment, if any. I/We understand that this release and indemnification shall survive the end of my/our child’s participation in the activities referenced on this form and shall have no limitation in time or amount.

  • • PRESCRIPTION MEDICATIONS must include signature authorization from the child's physician. Prescription medications will NOT be administered without physician consent.
    • OVER-THE-COUNTER MEDICATIONS require parent authorization only.
    Medications must be in the original labeled container (no baggies, foil, etc.). Pharmacists can provide a duplicate labeled container.
    • Parent/guardian must provide the medication, related equipment required and specific instructions. The child MAY NOT bring these materials to camp or Mission Network Activities USA, Inc. activities.
    • Medication changes or dosage changes must be noted on a NEW medication authorization form. It is the responsibility of the parent/guardian to inform the Mission Network Activites USA, Inc Club Volunteer or any changes.
    • New medication or dosage changes will not be given unless a newly labeled container is provided.
    • Unused medication will be disposed of unless picked up within one week after medication is discontinued.
    • Medication will be administered as follows:
  • Name of Medication
  • Dose
  • Administration Time
  • Illness/Symptoms in which child may require medication as necessary
  • Physician's Name
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    Physician Phone

    I the minor’s parent and/or legal guardian, understand the nature of the event’s activities and the minor’s experience and capabilities and believe the minor to be qualified, in good health, and in proper physical condition to participate in such activity. I hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless each of the releasees from all liability claims, demands, losses, or damages on the minor’s account caused or alleged to be caused in whole or in part by the negligence of the "releasees" or otherwise, including negligent rescue operation and further agree that if, despite this release, the minor, or anyone on the minor’s behalf, or I make a claim against any of the releasees named above, I will indemnify, save, and hold harmless each of the releasees from any litigation expenses, attorney fees, loss liability, damage, or cost any may incur as the result of any such claim. I have read and fully understand the “waiver and release of liability, assumption of risk, and indemnity” and the “parental consent agreement.” I am aware that this is a release of liability and a contract between the New Orleans Mission and me. On this date, I have signed on my own free will.
  • By completing and submitting this Agreement and checking the “I agree” box, you are consenting to the terms and provisions, as well entering into this Agreement in electronic form. You hereby agree that the accompanying electronic signature is valid for all purposes, as defined by law.