Registration BCH Use Only

I, (NAME ON THIS REGISTRATION FORM), an adult [age of majority, per State (e.g., 18 years old in California)] and I am the named participant, or I am the parent/guardian of the minor who will be participating all of Doan Dominico Savio and church related activities organized and/or sponsored by the Vietnamese Eucharistic Youth Movement in the USA (VEYM). I am fully aware that my or my child’s participation is totally voluntary. I am aware that these events may involve the following activities but not limited to: running, jumping, sharing personal stories, singing, clapping, shouting, sitting for prolonged periods of time, early wake- up, sleeping in cabins, use of low-light restrooms, outdoor activities in dirt and rocky terrain, sleeping outdoors, activities relating to outdoor environment, aquatic activities and OTHER TRAINING ACTIVITIES. In consideration of VEYM’s agreement to permit me or my child to participate in all the events, the receipt and sufficiency in which consideration is hereby acknowledged, I agree as follows:

I,(NAME ON THIS REGISTRATIOM FORM), HEREBY: Release, acquit and forever discharge VEYM and their employees, volunteers, agents, servants, officers, trustees, representatives, affiliates, and sponsors, in their official and individual capacities, as well as my Parish and my Diocese, their employees and agents, representatives, sponsors, chaperones, or volunteers, from any and all liability whatsoever for any and all damages, injuries (including death) to persons, loss to property, or both, which arise during, out of, or in connection with my participant in the events, including but not limited to, those related activities directly or indirectly leading up to and stemming from the events, even those activities which arise out of my travels to and from these events; ____ (please initial for concurrence)

I, (NAME ON THIS REGISTRATION FROM), HEREBY: Agree to indemnify (compensate for harm or loss), defend and hold harmless the VEYM and their employees, volunteers, agents, servants, officers, trustees, representatives, affiliates, and sponsors, in their official and individual capacities, as well as my Parish and my Diocese, their employees and agents, representatives, sponsors, chaperones, or volunteers, against all claims, including, but not limited to, claims of negligence, unintentional acts, and acts of omission, and from any and all liability, loss or damage they sustain as a result of any claims, demands, actions, causes of action, judgments, costs or expenses they incur, including attorney’s fees, which result from or arise out of my or my child’s participation in The Event, including but not limited to, my travel to and from The Event. ________ (please initial for concurrence)

I HERBEY ACKNOWLEDGE AND ACCEPT THAT:There are certain inherent dangers and foreseeable and unforeseeable risks of harm to myself, my child and other arising from The Event’s various activities, including but not limited to, sustaining bodily or emotional injury, that could result from my participation in The Event. I have knowingly and voluntarily decided to assume the risks of these inherent dangers in consideration of VEYM’s permission to allow me or my child to participate in The Event. ________ (please initial for concurrence)

I HEREBY ACKNOWLEDGE AND ACCEPT THAT: Weather conditions, including Acts of God, or natural causes (which humans do not intervene to cause), may alter or affect plans, expenses, and activities relating to, and including, The Event, and I understand that inherent dangers and risks of harm to myself, my child and others as a result of such natural causes may vary, and I assume all foreseeable and unforeseeable risks of harm I or my child may be exposed to therefrom;________ (please initial for concurrence)

I HEREBY ACKNOWLEDGE AND ACCEPT THAT: My or my child’s personal property may be at my risk of theft, damage or loss entirely; ________ (please initial for concurrence)

I HEREBY ACKNOWLEDGE AND ACCEPT THAT: VEYM reserves the right to decline, to accept, or retain me or my child in all the events at any time should my actions or general behavior impede the operation of all the events or the rights or welfare of any other person. I understand that I or my child may be required to leave any events in the sole discretion of VEYM’s agents and representatives. If I am or my child is required to leave, no refund will be given to me or my child for any unused portion of all the events, and VEYM will not reimburse me for any alleged direct or indirect costs or expenses I or my child incurred as a result of my or my child’s participation in all the events ________ (please initial for concurrence)

I HEREBY ACKNOWLEDGE AND ACCEPT THAT: I understand that VEYM, in its sole discretion, reserves the right to cancel any events or any aspect thereof prior to commencement. In the event of cancellation of any events in whole or in part, I accept that I or my child may not be reimbursed or refunded for any unused portion of the events ________ (please initial for concurrence)

I UNDERSTAND: I represent and warrant that I am or my child is covered throughout any events by a policy of comprehensive health and accident insurance which provides coverage for injuries which I or my child may sustain as part of my or my child’s participation in any events. Even if I am or my child is not covered by any health insurance during any events, however, I agree to complete the HEALTH INFORMATION section to the best of my ability and, by its completion, I hereby release and discharge VEYM of all responsibility and liability for any injuries, illnesses, medical bills, charges or similar expenses I may incur while participating in any events. By completing the form, I hereby authorize VEYM to obtain any necessary medical treatment to myself or my child, consent to any necessary examination, treatment, or care under the supervision and/or advice of any properly licensed medical professional, and I explicitly authorize VEYM to release medical information about me or my child to any person or entity to whom VEYM refers me for medical treatment. ________ (please initial for concurrence)

I UNDERSTAND: To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence.

I UNDERSTAND: I hereby grant VEYM my consent without reservation to use, assign, convey, reproduce, copyright, publish or sell my name, voice, image, and/or likeness that arise from my participation in The Event, whether still or motion pictures, audio or video tape, for promotional, instructional, business or any other lawful purposes, at VEYM’s sole discretion.

IN SIGNING THIS AGREEMENT, I HEREBY ACKNOWLEDGE AND REPRESENT THAT I HAVE READ THIS ENTIRE DOCUMENT, THAT I UNDERSTAND ITS TERMS AND PROVISIONS, THAT I UNDERSTAND IT AFFECTS MY OR MY CHILD’S LEGAL RIGHTS, THAT IT IS A BINDING AGREEMENT, AND THAT I HAVE SIGNED IT KNOWINGLY AND VOLUNTARILY. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.