1. In signing this form, I hereby state that the information in this form is correct and give permission for my child to participate in the activity described on this form. 
2. I recognize that there are risks inherent in participating in any activity, I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend the Archdiocese of St. Louis, its affiliates and its employees, volunteers and agents, from any injury to my child or damage to or loss of personal property of my child not caused by the negligence or misconduct of the Archdiocese of St. Louis, its affiliates and its employees, volunteers and agents.
3. I agree to compensate the Archdiocese of St. Louis, its parishes, clergy, officers, directors, employees and agents, chaperones, or representatives associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from negligence of the parish/diocese.
4. I hereby warrant that to the best of my knowledge my child is in good health and I assume all responsibility for the health of my Child. In the case of a medical emergency, I understand that every effort will be made to contact me; but in the event that I cannot be reached, I hereby give permission for my child to be evaluated, diagnosed, and treated in accordance with standard medical practice by licensed medical personnel.
5. I hereby grant permission for non-prescription medication (aspirin, ibuprofen, cough drops, etc.) to be given to my child if appropriate.
6. I hereby give permission to IMPACT Youth Ministry and the parishes they serve to use any photographs or video footage taken of my child in print and on their website for promotional purposes.
7. I understand that for all Youth Ministry activities there is a zero tolerance policy for the use of any mood altering chemicals (including alcohol and drugs), foul language, threats or any types of abuse, inappropriate behavior, and inappropriate physical contact. My child agrees to follow this policy.