Lock-In Consent & Liability Waiver

CONSENT TO TREATMENT OF PARTICIPANT: I am the custodial parent or legal guardian of Participant. I hereby warrant that to the best of my knowledge, Participant is in good health and physically able to participate in the Auction Lock-in and I assume all responsibility for the health and physical condition and ability of Participant to so participate. In the event of circumstances that indicate that Participant is in need of immediate medical care, I authorize and give permission for Participant to be transported to a hospital/clinic/medical facility for evaluation and emergency medical or surgical treatment, including any necessary X-ray examination. I authorize any licensed physician or medical center to treat Participant. I accept full responsibility for any medical or hospital bills associated with the care of Participant.

LIABILITY WAIVER: In consideration of the arrangement set forth herein, I do on behalf of myself, Participant and our respective heirs, successors, assigns and next of kin, release, waive, hold harmless, defend and covenant NOT TO SUE, Christ the King Catholic Church/School, the Archbishop of the Archdiocese of Oklahoma City, and the Archdiocese of Oklahoma City and each of their respective departments, directors, administrators, teachers, officers, agents, representatives, volunteers and employees from any and all actions, claims, demands or liabilities, including without limitation, those for personal injuries or property damage, that I and/or Participant may suffer due to illness or injury suffered by Participant as a result of, or in connection with, participation in the RE/Youth Activities, including the administration of authorized medications, medical treatment and any consequences that may arise as the result of said treatment, including without limitation, housing, meals and collateral entertainment to the fullest extent permitted by law.

Name of Activity:

Participant's First Name:

Participant's Last Name:

Mother's Name:

Mother's Cell Phone Number:

Father's Name:

Father's Cell Phone Number:

Emergency Contact Other than Parents/Guardian(s):

Emergency Contact Phone Number:

Does your child have any allergies? (e.g., insects, hay fever, strawberries, peanuts, etc.)

PARTICIPATION PERMISSION: I, the undersigned, am custodial parent/legal guardian of Participant and request that he/she be to allowed participate in the Auction Lock-in, held at Christ the King Catholc Church/School.

Acknowledgement of statement above: PARTICIPATION PERMISSION

LOST OR STOLEN ITEMS: I hereby understand and agree that neither the Archdiocese of Oklahoma City or Christ the King Catholic Church/School nor any of their respective employees, directors, officers, agents, representatives and/or volunteers shall be held liable for any of my or my child’s personal property lost or stolen during participation in the Auction Lock-in.

Acknowledgement of statement above: LOST OR STOLEN ITEMS

I certify to that the information contained herein is true and correct to the best of my knowledge and that I fully understand the terms and legal consequences of my execution of this REGISTRATION CONSENT AND WAIVER FORM FOR AUCTION LOCK-IN.

I understand that checking box below constitutes that the below is a legal signature, all the above information is true and that I acknowledge and agree to the permission being asked for in this Waiver Form.

Acknowledgement of statement above: CONSENT AND WAIVER FORM FOR AUCTION LOCK-IN

Custodial Parent/Guardian Signature:

Date:

Email for Reciept:

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Christ The King School

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Christ The King School

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Lock-In Consent & Liability Waiver