This Release Form is completed and signed of my own free will with the sole purpose of authorizing medical treatment under emergency circumstances in my absence. 

Your son, daughter, or legal ward is eligible to participate in a Church-sponsored activity requiring transportation to Fortune Lake Bible Camp in Crystal Falls, MI. This activity will take place under the guidance and supervision of adult chaperones. A brief description of the activity follows: 

Name of Event: Youth Encounter weekend retreat 
 
Destination:  Fortune Lake Camp, 138 Fortune Lake Camp Road, Crystal Falls, MI 49920
(906) 214-2267
 
Designated Supervisor of Activity:  Father Ryan Ford
 
Date and Time of Activity:  Friday, October 22nd, 2021 at 6:30 p.m. Central Time 
through Sunday, October 24th, 2021 at 5:30 p.m. Central Time .
 
Method of Transportation: Carpooling 
 
Cost: $35

If you would like your child or ward to participate in this event, please read and acknowledge the following statement of consent and release of liability. As parent or legal guardian, you remain fully responsible for the actions and conduct of your child. 

I hereby consent to participation by my son, daughter, or legal ward in the event described above. I understand that this event will take place on parish grounds and that my child will be under the supervision of designated adults on the stated dates. I further consent to the conditions stated above on participation in this event, including the method of transportation. 

In consideration of my child being allowed to participate in this activity, I hereby agree on behalf of myself and my child, to release the individuals in charge, the Roman Catholic Diocese of Marquette, St. John The Evangelist parish, Fortune Lake Bible Camp and any and all affiliated organizations, their employees, agents and representatives, including volunteer drivers (collectively “Releases”) 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 activity. In the event this release on behalf of myself and/or my child is held to be invalid or unenforceable, I hereby agree to indemnify and hold harmless Releases 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 the activity. 

This release or indemnification 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. 

By clicking below, I am providing my consent.