This form is for our January Confirmation Retreat option on January 23rd-24th. 

This is a non-overnight retreat at St. Odilia. Kids will be dropped off Friday evening and pickup at the end of the night, then brought back the next morning. 

Please email Ricky if you have any questions about food accomodations, schedule, etc. pipala@stodilia.org

I, parent or guardian of the above child (ren) grant permission for my child(ren) to participate in this parish/school event. This event will take place under the guidance and direction of parish/school employees and/or volunteers from St. Odilia Catholic Church.

I understand and agree that as parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above-named minor (“student/participant”). Further, 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.

I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend St. Odilia Catholic Church, its officers, directors, employees and agents, and the Archdiocese of Saint Paul and Minneapolis, its employees and agents, chaperones, or representatives associated with the event and activities (hereinafter “Releasees”), from any claim, including but not limited to all claims relating to communicable disease, arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate Releasees 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 the negligence of Releasees and is not related to communicable disease (see communicable disease release, hold harmless and indemnification agreement below).

Communicable Disease Release, Hold Harmless & Indemnification Agreement: I agree to hold Releasees harmless, release, defend, and indemnify Releasees for any communicable disease clam arising out of the above Event that is brought against Releasees by myself, participant, my family members, heirs, assigns, executors, and personal representatives. I understand and agree this communicable disease release, hold harmless, and indemnification agreement includes claims based on the actions, omissions, or negligence of participant, myself, and others including but not limited to the Releasees.

If you choose "No" please note that this may disqualify you from participation in this Event/Activities.

I HAVE READ THE ABOVE PARENTAL AUTHORIZATION, RELEASE & INDEMNITY AGREEMENT, ITS DISCLOSURES, AUTHORIZATIONS, AND RELEASES. I UNDERSTAND AND AGREE I HAVE HAD THE OPPORTUNITY TO CONSIDER THE TERMS AND UNDERSTAND THEM. BY MY SIGNATURE BELOW, I UNDERSTAND AND AGREE I AM VOLUNTARILY ACCEPTING ALL THE PROVISIONS WITH FULL KNOWLEDGE OF THE SIGNIFICANCE. FURTHER, I ACKNOWLEDGE AND AGREE THIS ELECTRONIC OR DIGITAL SIGNATURE IS THE LEGALLY BINDING EQUIVALENT TO MY HANDWRITTEN SIGNATURE.