THE PERMISSION / LIABILITY / MEDICAL RELEASE FORM

PARTICIPANT’S NAME _______________________________________________________

ADDRESS ________________________________________ CITY ____________________

ZIP _______	 PHONE ___________________ ALTERNATIVE PHONE _________________

NATURE OF THE EVENT
I understand that serving in kitchen crew for a COR retreat includes transportation to and from the St. Leonard Youth Retreat Center, and any other transportation my child will use during the COR retreat. I understand that direct supervision of my child will be limited to the preparation and serving of meals, the clean-up, the planning and performing of entertainment, the decorating , the washing and cleaning, the overnight stay, if applicable, but not to the times not listed on the Registration Form.

PERMISSION
I grant my child permission to participate in the COR Retreat of                              , 200     as a Kitchen Crew member. 

(If applicable) I grant my child permission to stay overnight at the St. Leonard Youth Retreat Center during the COR retreat of                                , 200     .

LIABILITYI release and discharge the COR Retreat, each of its agents and volunteers, and the Congregation of St. Joseph from any liability whatsoever resulting or arising out of any injury or damage which may occur on account of my child’s /my own participation in the COR Kitchen Crew event of APRIL 23-24-25, 2004, or the transportation connected therewith. 

MEDICAL RELEASE
In the event that emergency treatment be needed, permission is hereby given to provide whatever treatment be necessary for the applicant. I accept responsibility for any medical bills that may accrue. The COR Retreat or the Congregation of St. Joseph are not responsible for any medical bills incurred on the weekend of                                  , 200     .

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		Parent or Guardian Signature					Date