I,___________________________________________ hereby agree to assume full responsibility for the payment of all debts incurred by my child _____________________________________during his/her visit to__________________________________________________ and to reimburse the Diocese of Palm Beach (and any other participating organizations) for any damages suffered by it due to my child's acts during the trip.
I further agree to release and hold the Diocese of Palm Beach (and any other participating organizations) harmless for and against all claims, judgments, costs or other expenses arising out of bodily injuries, property damage, or other loss suffered by my child during the trip.
I authorize the Diocese of Palm Beach (and any other participating organization) to procure, at my expense, any medical care reasonably required for my child during the trip.
In the event of an emergency, please notify:
Name:__________________________________________________
Address:_______________________________________________
City, St., Zip:________________________________________
Phone:(_____)__________________________________________
Signature:_____________________________________________
Date:____________________________