Please list any dietary or medicinal allergies or current medications in box below.
I request that the St. Thomas Aquinas Life Teen program allow my teenager named above to attend the Fall 2017 Retreat on October 27-29 at UCYC in Prescott, AZ. In consideration for my teenager's participation, on behalf of myself, my teenagers, and our heirs, assigns, executors, and personal representatives, I hereby release, absolve, indemnify and agree to hold harmless St. Thomas Aquinas Catholic Parish in Avondale, the Roman Catholic Church of the Diocese of Phoenix, and any and all of their officers, directors, agents, employees, representatives, volunteers, or sponsors from any and all liability for any and all injury that may arise out of participation in this activity. I authorize the supervisor of the retreat or his/her designee to provide first aid or similar care in non-emergency situations and to seek emergency medical assistance when they deem it necessary, for which I will be financially responsible. I also agree to release, absolve and hold harmless St. Thomas Aquinas Catholic Parish for any and all damage sustained to my vehicle should I choose to leave it in the parking lot while attending this event. Further, I give permission to have photographs taken of my teenager for the purpose of parish use.