COR REGISTRATION FORM

Nature of the event:
The COR RETREAT is a Catholic Youth Weekend Retreat held on the grounds of the St. Leonard Youth Retreat Center and  sponsored by the Congregation of St. Joseph.

Nature of risks:
I  understand that voluntarily traveling to the COR RETREAT, participating in the various activities connected with it  and returning home from it, may involve certain risks beyond the reasonable control of the Congregation of St. Joseph, the COR RETREAT organizers, leaders and agents, including, but not limited to, accidents, emergencies, exposure to reckless conduct of other persons. I understand that the Congregation of St. Joseph disclaims any and all responsibility for such risks.

Registration

Name _____________________________________________Phone ____________________

Address ______________________________ City _____________________ ZIP _________

E-Mail ____________________________________ Emergency # ______________________

School you attend _____________________________ Your Age ____

Name of Parents / Guardians ____________________________________________________

Waiver of Liability
By signing this Liability Waiver I agree and acknowledge that I may be giving up important legal rights and remedies available to myself, my family, my heirs, successors, and assigns (“Our Behalf”). I agree on behalf of myself, my child’s other parent if known or living, my  child named herein and Our Behalf to assume all risks and hold harmless and defend the Congregation of St. Joseph and the organizers and agents of the COR RETREAT with respect to any and all actions , claims or demands arising out of or in connection with travel to and from or attendance at the event, or any other activity my child may engage in while at the COR RETREAT., and I agree to compensate the Congregation of St. Joseph and its agents for reasonable attorney’s fees and expenses arising in connection therewith.

Medical Release
In the event of injury or illness to my child during the duration of the COR RETREAT, and reasonable attempts to contact me or another person at the above numbers having proven unsuccessful, I hereby give my full consent for the administration of emergency medical treatment deemed necessary by a licensed physician or dentist. This authorization does not cover major surgery unless the medical opinion of two other licensed physicians or dentists, concurring on the necessity for such surgery, are obtained prior to the performance of such surgery.

Permission
Based on all the foregoing, I grant permission for my child to participate in COR RETREAT on                                , 200        at the St. Leonard Youth Retreat Center in Avon, OH. I fully understand the consequences of and sign this Waiver of Liability, Medical Release and Permission knowingly, freely and willingly.

Signature of Parent or Guardian _______________________________________    Date ___________________

Signature of Participant, if 18 or older ________________________________________   Date _______________