This Registration must be submitted to Mike Krueger at the

St. Francis Church office by Wednesday, July 30, 2008.

Ph: (231) 947-4620 ext.222

REGISTRATION for

I Can? Canoe? event

with St. Francis Church Youth Group

Friday, August 8, 2008

Eligible Students in Grades 7 – 12 (fall 2008)

Full Name

____________________________________________________________

Address (Street)_______________________________________________

___________________________________________________

(City)                                        (State)                                        (Zip Code)

Phone Number_____________________________________

Emergency Phone Number_____________________________

Age____________       Birth Date_____________

Grade (fall ’08)____________  

Mothers Full Name____________________________________

Fathers Full Name____________________________________

Please complete both the Registration and Parental Permission sections.

Parental Permission

Dear Parent or Legal Guardian:

    Your son/daughter is eligible to participate in the I Can! Canoe? event with St.

Francis Parish Youth Group, which will require transportation to locations away

from the parish premises. All activities will take place only under the guidance and

supervision of employees and volunteers from St. Francis Parish.

     If you would like your child to participate in the I Can! Canoe? event, please

complete, sign and return the following statement of consent and release of liability.

As a parent or legal guardian, you remain fully responsible for the actions and conduct

of your child.

Statement of Consent

    I hereby consent to the participation by my child,___________________________,

in the I Can! Canoe? event with St. Francis of Assisi Parish Youth Ministry Program on

August 8th, 2008. I understand that some events may take place away from Parish

Grounds and that my child will be under the supervision of St. Francis of Assisi Parish

employees and volunteers.

    I further give permission for any photos or video images taken of my child during

this event, to be used in further publicity (i.e. print, broadcast, website) efforts of

St. Francis of Assisi Parish.

    In consideration of my child being allowed to participate in this program, I hereby

agree on behalf of myself and my child to release St. Francis of Assisi Parish, the Roman

Catholic Diocese of Gaylord, any and all affiliated organizations, their employees, agents

and representatives, including volunteer and other drivers (collectively “Releasees”),

from any and all claims, including negligence, arising from or relating to my child’s

participation in this group.  In the event this release on the behalf of myself and/or my

child is held to be invalid or unenforceable, I hereby agree to indemnify and hold harmless

Releasees from any and all claims, including negligence, which may be asserted by me or

my child, or on behalf of my child, arising from or relating to my child’s participation in

this program. This indemnification and hold harmless agreement does not apply to claims

for intentional misconduct or gross negligence; nor does this release or indemnification

apply to the extent of commercial insurance coverage for any claim, but this Release or

Indemnification shall apply to the extent of any self-insurance or deductible applicable to

any claim.

_________________________________________            _________________

 (Print Parent Name)                                                                                   Date)

_________________________________________

 (Parent Signature)