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Print this
form and include it with your registration.
I/we as the
parent(s) or legal guardian(s) of
(participant's name)
______________________________________,
do hereby grant permission for aforesaid
participant to participate in the 1998 Youth in
the City Program of CYO & Community Services,
Inc. and the Youth & Young Adult Ministry and
CYO Office which provides a week long service and
social justice experience working with children,
adults and senior citizens in urban areas and
hereby grant permission for aforesaid participant
to be housed at Parmadale, 6753 State Rd, Parma
from August 2 - 7, 1998 and hereby grant
permission for aforesaid participant to travel as
part of the group to experience various settings
within Diocese of Cleveland and hereby
acknowledge that the above named person
will travel to and from these activities in
transportation arranged by CYO & Community
Services and Youth & Young Adult Ministry and
CYO Office using approved staff and volunteer
drivers and furthermore grant permission and
acknowledge that aforesaid participant will be
involved in some activities that require some
physical labor (i.e. cleaning, minor home
repairs, lifting boxes, painting, equipment, and
supplies; using a ladder) and therefore agree by
my/our mutual signature(s) to release, absolve,
indemnify and hold harmless, Youth in the City
Programs, CYO & Community Services, the Youth
& Young Adult Ministry and CYO Office, the
Catholic Charities Services Corporation, Catholic
Charities, and its affiliates, the Roman Catholic
Diocese of Cleveland, the Bishop of the Roman
Catholic Diocese of Cleveland, and any and all
Catholic Churches or Parishes, and any and all
supervisors, organizers, or sponsors of, and from
any and all liability for injury, medical fees,
hospital bills, or doctor bills of aforesaid
participant, and I/we waive all claims of any
kind against any or all of the organizations or
persons hereinabove enumerated, including any and
all claims against any person or persons
transporting aforesaid participant to or from any
activities hereinabove named. This release
is for any and all programs sponsored by Youth in
the City Program that aforesaid participant
elects to participate for the duration of his/her
eligibility in the program. I hereby give
my consent to photograph aforesaid participant
and without limitation, to use such photographs
and or stories in connection with any work of CYO
& Community Services and Youth & Young
Adult Ministry & CYO Office without
consideration of any kind, and I do hereby
release CYO & Community Services and Youth
& Young Adult Ministry & CYO Office from
any claims whatsoever which may arise in said
regard.
______________________________________________________
(Mother/Father or
Guardian's signature or Participant's signature
if 18 years or older.)
Date____________
______ $50 Deposit Enclosed
Registration deadline is July 24, 1998.
Mail to: Youth in the City
Youth & Young Adult Ministry and CYO
Office
1031 Superior Avenue
Cleveland, OH 44114
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