Permission and Release to Our Lady of Lourdes School/Parish – West Islip:
8th Grade Retreat to Saltaire Retreat House (Fire Island) on Wednesday, October 22nd.
I hereby grant permission, without reservation, for my child, ______(“my child”), to participate in the 8th Grade Retreat to be taken to The Saltaire Retreat House on Fire Island on/from Wednesday, October 22nd .
Further, I hereby grant permission, without reservation, to Our Lady of Lourdes School/Parish, and to those authorized by Our Lady of Lourdes School/Parish, to transport me (if applicable) and my child in connection with the Trip and to and from all Trip-related events. In addition, I hereby grant permission, without reservation, for my child to partake in all Trip-related activities, direct or indirect, including, but not limited to, meals, lodging, and recreational activities.
I acknowledge and affirm that there are risks inherent in travel and that Our Lady of Lourdes School/Parish cannot guarantee the personal safety of me (if applicable) and my child or the safety of my and my child’s property while he/she is participating in the Trip or in any Trip-related activities, including, but not limited to, travel, transportation, meals, lodging, or recreational activities. I hereby release Our Lady of Lourdes School/Parish, its officers, directors, agents, employees, independent contractors, licensees and assignees from all claims that I may have relating to injury or damage suffered or incurred by me or my child in connection with the above described inherent risks.
I hereby grant permission, without reservation, to Our Lady of Lourdes School/Parish, and to those authorized by Our Lady of Lourdes School/Parish], to take photographs and to make recordings of me (if applicable) and/or my child, and to use them in original or modified form in all media now or hereafter known, with or without name or information, solely for the promotion, public education, and/or fundraising activities of Our Lady of Lourdes School/Parish. I understand and agree that I am entitled to receive no compensation for the above. I release Our Lady of Lourdes School/Parish, its officers, directors, agents, employees, independent contractors, licensees and assignees from all claims that I now have or in the future may have, relating to the above. I further agree that Our Lady of Lourdes School/Parish will be the sole owner of all tangible and intangible rights in the abovementioned photographs and recordings, with full power of disposition.
I am the parent or guardian of the minor named above, and I hereby consent to the foregoing on behalf of the minor and myself.
Date______
Student Name (print)______Homeroom/Grade:______
Parent/Guardian Name (print)______Address______
Parent/Guardian Signature______Emg. Cell/Phone ______
Cost of Trip $20.00
Due Date: Monday, October 6, 2014.