Parental Permission and Liablity Release Form

Parental Permission and Liability Release: As parent/legal guardian of the participant named above, I give my child permission to fully participate in the Office for Parish Life sponsored youth program, Lead Like Jesus, High School Leadership Retreat, to be held at Chapman Lake Retreat Center (287 Chapman Lake Road) from Friday, March 20th to Sunday, March 22nd, 2026. I will not hold the Office for Parish Life, nor the Diocese of Scranton, chaperones, or representatives associated with the above-mentioned program and the activities associated with participating in the above, responsible in the event of an incident or injury. I further understand on behalf of myself, my family, my heirs, successors that I assume all risks and generally release and waive any liability of any nature. I further agree not to file any lawsuits against the Office for Parish Life, Diocese of Scranton and their representatives associated with this event. Additionally, I will not hold the above-mentioned parties responsible for property damage and expenses of any nature whatsoever which may be incurred by the participant resulting from said participant’s involvement in the above-mentioned event (including transportation to and from the event).

Informed Consent to Medical Treatment: I request that in my absence the above-named minor be admitted to any hospital or medical facility for diagnosis and treatment. I request and authorize physicians, dentists, and staff, duly licensed as Doctors of Medicine or Doctors of Dentistry or other such licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of the above minor. I authorize the hospital or medical facility to dispose of any specimen or tissue taken from the above-named minor. I assume full responsibility for all costs of such treatment. Further, should it be necessary for the participant to return home due to medical, disciplinary, or other reasons, I do hereby assume responsibility for the participant’s transportation home and any costs related thereto.

Photo, Press, Audio, and Electronic Media Release: I authorize the Diocese of Scranton, its parishes, its schools and/or the Catholic Light and other diocesan communications platforms to use and publish my child’s photograph, video and/or audio recording along with their name identifying them for educational, news stories, illustration and/or marketing purposes.

I understand and herby agree to the terms and conditions of the participant’s involvement in the above-described event, and I freely execute this acknowledgement with full knowledge of its content.