Common use of Parent/Guardian Clause in Contracts

Parent/Guardian. I agree to instruct my child to abide by all rules and regulations as outlined by NFCYM, particularly the Youth Participant Code of Conduct ("Code") (xxxxx.xxx/xxxxxxxxxxxxxxx) and Behavior Guidelines for the NCYC (“Guidelines”) (xxxxx.xxx/xxxxxxxxxxxx). I understand it is my legal duty to review and explain Code and Guidelines to my child prior to signing this Agreement. I agree that if my child fails in any way to abide by Code or Guidelines, my child can be dismissed from NCYC and sent home immediately with no right of reimbursement or refund for any amount in connection therewith from NFCYM et al. or Diocese et al. Initials of Parent/Guardian Youth: As a participant in NCYC, I agree to conform to the NFCYM Youth Participant Code of Conduct (xxxxx.xxx/xxxxxxxxxxxxxxx) and Behavior Guidelines for the NCYC (xxxxx.xxx/xxxxxxxxxxxx). I also understand and agree that my parent/guardian will be notified of any infractions requiring my dismissal from NCYC, and I will be sent home at my parent's/guardian's expense. Among other things, being found with any alcoholic beverages, drugs, or weapons is cause for automatic dismissal from NCYC. Initials of Youth NCYC Fee Nonrefundable: I agree that if my child suffers an illness requiring dismissal from NCYC, there is accident or emergency requiring dismissal of my child from NCYC, my child commits an infraction of Code, or if NCYC must be discontinued in event of accident or emergency, my child must return home at my expense, and I assume the risk of any loss of any nonrefundable or additional costs associated with travel and fees for NCYC, with no right of reimbursement or refund for any amount in connection with therewith from NFCYM et al. or the Diocese et al. Insurance: NFCYM urges you to purchase travel or other insurance to cover the risks you have assumed under this Legal Agreement. Please indicate below:   YES, I have purchased a travel or other insurance package to manage any risks I may experience by attending NCYC. NO, I knowingly declined to purchase an insurance package and acknowledge that I declined this risk management opportunity. I fully understand the consequences of and sign this LEGAL AGREEMENT - GENERAL RELEASE, COVENANT NOT TO SUE, LIABILITYWAIVER, AND PERMISSION AGREEMENT knowingly, freely, and willingly. If any provisions of this Agreement shall be held to be invalid or unenforceable for any reason, the remaining provisions shall continue to be valid and enforceable. I understand this Legal Agreement must be printed then signed by hand. Failure to notarize does not diminish legal validity of this Legal Agreement. A typed name does not constitute a signature. Signature of Parent or Guardian Date Signature of Youth Date NOTARY (Mandatory only if Required by Diocesan Policy) City/County of ; State of On this day of , 2019, before me personally appeared the adult named xxxxxxxxxxx, who is personally known to me or produced positive identification, and who executed the foregoing LEGAL AGREEMENT – GENERAL RELEASE, COVENANT NOT TO SUE, LIABILITY WAIVER, AND PERMISSION AGREEMENT, and acknowledged that s/he executed the same as her/his free act and deed. [NOTARIAL SEAL] Signature of Notary Public: My commission expires:

Parent/Guardian. I agree to instruct my child to abide by all rules and regulations as outlined by NFCYM, particularly the Youth Participant Code of Conduct ("Code") (xxxxx.xxx/xxxxxxxxxxxxxxx) and Behavior Guidelines for the NCYC (“Guidelines”) (xxxxx.xxx/xxxxxxxxxxxx). I understand it is my legal duty to review and explain Code and Guidelines to my child prior to signing this Agreement. I agree that if my child fails in any way to abide by Code or Guidelines, my child can be dismissed from NCYC and sent home immediately with no right of reimbursement or refund for any amount in connection therewith from NFCYM et al. or Diocese et al. Initials of Parent/Guardian Youth: As a participant in NCYC, I agree to conform to the NFCYM Youth Participant Code of Conduct (xxxxx.xxx/xxxxxxxxxxxxxxx) and Behavior Guidelines for the NCYC (xxxxx.xxx/xxxxxxxxxxxx). I also understand and agree that my parent/guardian will be notified of any infractions requiring my dismissal from NCYC, and I will be sent home at my parent's/guardian's expense. Among other things, being found with any alcoholic beverages, drugs, or weapons is cause for automatic dismissal from NCYC. Initials of Youth NCYC Fee Nonrefundable: I agree that if my child suffers an illness requiring dismissal from NCYC, there is accident or emergency requiring dismissal of my child from NCYC, my child commits an infraction of Code, or if NCYC must be discontinued in event of accident or emergency, my child must return home at my expense, and I assume the risk of any loss of any nonrefundable or additional costs associated with travel and fees for NCYC, with no right of reimbursement or refund for any amount in connection with therewith from NFCYM et al. or the Diocese et al. Insurance: NFCYM urges you to purchase travel or other insurance to cover the risks you have assumed under this Legal Agreement. Please indicate below:   🞏 YES, I have purchased a travel or other insurance package to manage any risks I may experience by attending NCYC. 🞏 NO, I knowingly declined to purchase an insurance package and acknowledge that I declined this risk management opportunity. I fully understand the consequences of and sign this LEGAL AGREEMENT - GENERAL RELEASE, COVENANT NOT TO SUE, LIABILITYWAIVER, AND PERMISSION AGREEMENT knowingly, freely, and willingly. If any provisions of this Agreement shall be held to be invalid or unenforceable for any reason, the remaining provisions shall continue to be valid and enforceable. I understand this Legal Agreement must be printed then signed by hand. Failure to notarize does not diminish legal validity of this Legal Agreement. A typed name does not constitute a signature. Signature of Parent or Guardian Date Signature of Youth Date NOTARY (Mandatory only if Required by Diocesan Policy) City/County of ; State of On this day of , 2019, before me personally appeared the adult named xxxxxxxxxxx, who is personally known to me or produced positive identification, and who executed the foregoing LEGAL AGREEMENT – GENERAL RELEASE, COVENANT NOT TO SUE, LIABILITY WAIVER, AND PERMISSION AGREEMENT, and acknowledged that s/he executed the same as her/his free act and deed. [NOTARIAL SEAL] Signature of Notary Public: My commission expires:

Parent/Guardian. I agree to instruct my child to abide by all rules and regulations as outlined by NFCYM, particularly the Youth Participant Code of Conduct ("Code") (xxxxx.xxx/xxxxxxxxxxxxxxx) and Behavior Guidelines for the NCYC (“Guidelines”) (xxxxx.xxx/xxxxxxxxxxxx). I understand it is my legal duty to review and explain Code and Guidelines to my child prior to signing this Agreement. I agree that if my child fails in any way to abide by Code or Guidelines, my child can be dismissed from NCYC and sent home immediately with no right of reimbursement or refund for any amount in connection therewith from NFCYM et al. or Diocese et al. Initials of Parent/Guardian Youth: As a participant in NCYC, I agree to conform to the NFCYM Youth Participant Code of Conduct (xxxxx.xxx/xxxxxxxxxxxxxxx) and Behavior Guidelines for the NCYC (xxxxx.xxx/xxxxxxxxxxxx). I also understand and agree that my parent/guardian will be notified of any infractions requiring my dismissal from NCYC, and I will be sent home at my parent's/guardian's expense. Among other things, being found with any alcoholic beverages, drugs, or weapons is cause for automatic dismissal from NCYC. Initials of Youth NCYC Fee Nonrefundable: I agree that if my child suffers an illness requiring dismissal from NCYC, there is accident or emergency requiring dismissal of my child from NCYC, my child commits an infraction of Code, or if NCYC must be discontinued in event of accident or emergency, my child must return home at my expense, and I assume the risk of any loss of any nonrefundable or additional costs associated with travel and fees for NCYC, with no right of reimbursement or refund for any amount in connection with therewith from NFCYM et al. or the Diocese et al. Insurance: NFCYM urges you to purchase travel or other insurance to cover the risks you have assumed under this Legal Agreement. Please indicate below:   YES, I have purchased a travel or other insurance package to manage any risks I may experience by attending NCYC.  NO, I knowingly declined to purchase an insurance package and acknowledge that I declined this risk management opportunity. I fully understand the consequences of and sign this LEGAL AGREEMENT - GENERAL RELEASE, COVENANT NOT TO SUE, LIABILITYWAIVER, AND PERMISSION AGREEMENT knowingly, freely, and willingly. If any provisions of this Agreement shall be held to be invalid or unenforceable for any reason, the remaining provisions shall continue to be valid and enforceable. I understand this Legal Agreement must be printed then signed by hand. Failure to notarize does not diminish legal validity of this Legal Agreement. A typed name does not constitute a signature. Signature of Parent or Guardian Date Signature of Youth Date NOTARY (Mandatory only if Required by Diocesan Policy) City/County of ; State of On this day of , 2019, before me personally appeared the adult named xxxxxxxxxxx, who is personally known to me or produced positive identification, and who executed the foregoing LEGAL AGREEMENT – GENERAL RELEASE, COVENANT NOT TO SUE, LIABILITY WAIVER, AND PERMISSION AGREEMENT, and acknowledged that s/he executed the same as her/his free act and deed. [NOTARIAL SEAL] Signature of Notary Public: My commission expires:

Parent/Guardian. I agree to instruct my child to abide by all rules and regulations as outlined by NFCYM, particularly the Youth Participant Code of Conduct ("Code") (xxxxx.xxx/xxxxxxxxxxxxxxx) and Behavior Guidelines for the NCYC (“Guidelines”) (xxxxx.xxx/xxxxxxxxxxxx). I understand it is my legal duty to review and explain Code and Guidelines to my child prior to signing this Agreement. I agree that if my child fails in any way to abide by Code or Guidelines, my child can be dismissed from NCYC and sent home immediately with no right of reimbursement or refund for any amount in connection therewith from NFCYM et al. or Diocese et al. Initials of Parent/Guardian Youth: As a participant in NCYC, I agree to conform to the NFCYM Youth Participant Code of Conduct (xxxxx.xxx/xxxxxxxxxxxxxxx) and Behavior Guidelines for the NCYC (xxxxx.xxx/xxxxxxxxxxxx). I also understand and agree that my parent/guardian will be notified of any infractions requiring my dismissal from NCYC, and I will be sent home at my parent's/guardian's expense. Among other things, being found with any alcoholic beverages, drugs, or weapons is cause for automatic dismissal from NCYC. Initials of Youth NCYC Fee Nonrefundable: I agree that if my child suffers an illness requiring dismissal from NCYC, there is accident or emergency requiring dismissal of my child from NCYC, my child commits an infraction of Code, or if NCYC must be discontinued in event of accident or emergency, my child must return home at my expense, and I assume the risk of any loss of any nonrefundable or additional costs associated with travel and fees for NCYC, with no right of reimbursement or refund for any amount in connection with therewith from NFCYM et al. or the Diocese et al. Insurance: NFCYM urges you to purchase travel or other insurance to cover the risks you have assumed under this Legal Agreement. Please indicate below:   🞏 YES, I have purchased a travel or other insurance package to manage any risks I may experience by attending NCYC. 🞏 NO, I knowingly declined to purchase an insurance package and acknowledge that I declined this risk management opportunity. I fully understand the consequences of and sign this LEGAL AGREEMENT - GENERAL RELEASE, COVENANT NOT TO SUE, LIABILITYWAIVER, AND PERMISSION AGREEMENT knowingly, freely, and willingly. If any provisions of this Agreement shall be held to be invalid or unenforceable for any reason, the remaining provisions shall continue to be valid and enforceable. I understand this Legal Agreement must be printed then signed by hand. Failure to notarize does not diminish legal validity of this Legal Agreement. A typed name does not constitute a signature. Signature of Parent or Guardian Date Signature of Youth Date NOTARY (Mandatory only if Required by Diocesan Policy) City/County of ; State of On this day of , 2019, before me personally appeared the adult named xxxxxxxxxxx, who is personally known to me or produced positive identification, and who executed the foregoing LEGAL AGREEMENT – GENERAL RELEASE, COVENANT NOT TO SUE, LIABILITY WAIVER, AND PERMISSION AGREEMENT, and acknowledged that s/he executed the same as her/his free act and deed. [NOTARIAL SEAL] Signature of Notary Public: My commission expires:: NFCYM, Inc. (7/19) Diocese of Superior August 2016 Permission Form for Minors with Indemnity Agreement and Emergency Contacts Child Information Full Name: Date of Birth: Gender: Female Male Address: Home parish name & city: Current Grade: T-Shirt Size: Event Information Description of Event: National Catholic Youth Conference (NCYC) – Indianapolis, IN – Xxxxx Oil Stadium. Includes general sessions, workshops addressing a variety of topics, opportunities for reconciliation, daily Mass, Eucharistic adoration, prayer, talks, sacraments, education, recreation, music, dancing, etc. Date of Event: November 21 – 23, 2019 Begin time: 11 pm Wednesday End time: 7pm Sunday (approximation) Transportation Method: Chartered buses Participant cost: $615 per person (includes, bus, conference, hotel, three breakfasts and t-shirt. Non refundable, but transferrable.) Sponsored by: Diocese of Superior, Office of Catholic Formation Supervised by: Xxxxxxxxxxx Xxxxxxxxx Your permission is needed for your child to participate in the event listed above. Please return this signed form no later than to . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - I give permission for my child to participate in the above named event. My signature below indicates that I understand the risks and hazards associated with the event this event, including injury, illness and the rare possibility of death. I understand that I may discuss any concerns or questions I have about this event with a representative of the parish or Diocese of Superior prior to giving permission for my child to participate. In consideration for my child’s participation, I agree to reimburse and indemnify the above named parish and the Diocese of Superior for all reasonable legal and court fees incurred by the parish/diocese in defending a lawsuit that I or my child may bring against the parish/diocese which relates to the above named event if the parish/diocese is found not legally liable by the courts and prevails in the lawsuit. If the parish/diocese is found legally liable for any injuries sustained by my child, this paragraph will not apply. I further agree to reimburse the diocese or any other agency for property damage or any bodily harm to other participants caused by my child. Parent/guardian signature: Date: Relationship to child: Phone numbers – Home: Work: Cell: Parents’ email address: EMERGENCY CONTACTS Name: Relationship: Phone – Home: Cell: Work: Name: Relationship: Phone – Home: Cell: Work: Xxxxx’s primary physician: Phone: Health system & location: Health insurance carrier: Policy number: A MEDICATION CONSENT FORM MUST BE COMPLETED AND THE PRODUCT SUPPLIED FOR EACH MEDICATION YOUR CHILD WILL NEED TO TAKE DURING THIS EVENT. ASK THE EVENT ORGANIZER FOR THIS FORM. (two sided form) Code of Conduct

Parent/Guardian. I agree to instruct my child to abide by all rules and regulations as outlined by NFCYM, particularly the Youth Participant Code of Conduct ("Code") (xxxxx.xxx/xxxxxxxxxxxxxxx) and Behavior Guidelines for the NCYC (“Guidelines”) (xxxxx.xxx/xxxxxxxxxxxx). I understand it is my legal duty to review and explain Code and Guidelines to my child prior to signing this Agreement. I agree that if my child fails in any way to abide by Code or Guidelines, my child can be dismissed from NCYC and sent home immediately with no right of reimbursement or refund for any amount in connection therewith from NFCYM et al. or Diocese et al. Initials of Parent/Guardian Youth: As a participant in NCYC, I agree to conform to the NFCYM Youth Participant Code of Conduct (xxxxx.xxx/xxxxxxxxxxxxxxx) and Behavior Guidelines for the NCYC (xxxxx.xxx/xxxxxxxxxxxx). I also understand and agree that my parent/guardian will be notified of any infractions requiring my dismissal from NCYC, and I will be sent home at my parent's/guardian's expense. Among other things, being found with any alcoholic beverages, drugs, or weapons is cause for automatic dismissal from NCYC. Initials of Youth NCYC Fee Nonrefundable: I agree that if my child suffers an illness requiring dismissal from NCYC, there is accident or emergency requiring dismissal of my child from NCYC, my child commits an infraction of Code, or if NCYC must be discontinued in event of accident or emergency, my child must return home at my expense, and I assume the risk of any loss of any nonrefundable or additional costs associated with travel and fees for NCYC, with no right of reimbursement or refund for any amount in connection with therewith from NFCYM et al. or the Diocese et al. Insurance: NFCYM urges you to purchase travel or other insurance to cover the risks you have assumed under this Legal Agreement. Please indicate below:   YES, I have purchased a travel or other insurance package to manage any risks I may experience by attending NCYC.  NO, I knowingly declined to purchase an insurance package and acknowledge that I declined this risk management opportunity. I fully understand the consequences of and sign this LEGAL AGREEMENT - GENERAL RELEASE, COVENANT NOT TO SUE, LIABILITYWAIVER, AND PERMISSION AGREEMENT knowingly, freely, and willingly. If any provisions of this Agreement shall be held to be invalid or unenforceable for any reason, the remaining provisions shall continue to be valid and enforceable. I understand this Legal Agreement must be printed then signed by hand. Failure to notarize does not diminish legal validity of this Legal Agreement. A typed name does not constitute a signature. Signature of Parent or Guardian Date Signature of Youth Date NOTARY (Mandatory only if Required by Diocesan Policy) City/County of ; State of On this day of , 2019, before me personally appeared the adult named xxxxxxxxxxx, who is personally known to me or produced positive identification, and who executed the foregoing LEGAL AGREEMENT – GENERAL RELEASE, COVENANT NOT TO SUE, LIABILITY WAIVER, AND PERMISSION AGREEMENT, and acknowledged that s/he executed the same as her/his free act and deed. [NOTARIAL SEAL] Signature of Notary Public: My commission expires: Acuerdo Legal de NFCYM/NCYC EXENCIÓN GENERAL, PACTO PARA NO DEMANDAR, EXONERACIÓN DE RESPONSABILIDAD Y ACUERDO DE PERMISO PARTICIPANTE JOVEN (Arqui) Diócesis de Parroquia/Escuela Instrucciones: A ningún menor se le permitirá asistir a la National Catholic Youth Conference (“NCYC”) auspiciada por la National Federation for Catholic Youth Ministry, Inc. (“NFCYM”) hasta que él o xxxx x xx padre/madre/tutor ejecute este Acuerdo Legal. Al firmar este Acuerdo Legal, usted acepta libre y voluntariamente que está renunciando a derechos y recursos legales disponibles para usted y su familia. Xxx y xxxxx cuidadosamente este Acuerdo Legal. Si tuviese preguntas, consulte con un abogado. No se podrá, ni se hará, cambio alguno a este documento. Ya que este Acuerdo contiene información de su contacto de emergencia, SE RECOMIENDA QUE EL MENOR GUARDE UNA COPIA FIRMADA DEL ACUERDO LEGAL EN SU DISTINTIVO DE IDENTIFICACIÓN Y QUE LA LLEVE CONSIGO DURANTE TODA LA NCYC. EN CASO XX XXXXX ALGUNA DISCREPANCIA SOBRE ESTA HOJA ENTRE LA VERSIÓN EN INGLÉS Y LA VERSIÓN EN ESPAÑOL, REGIRÁ LA VERSIÓN EN INGLÉS./IN THE EVENT THAT THERE MAY BE ANY CONFLICT BETWEEN THE ENGLISH AND SPANISH VERSIONS OF THIS FORM, THE ENGLISH VERSION SHALL GOVERN. Nombre del menor: Nombre del padre/madre/tutor: Dirección domiciliaria completa: Teléfono/casa: Fecha de nacimiento:

Parent/Guardian. I agree to instruct my child to abide by all rules and regulations as outlined by NFCYM, particularly the Youth Participant Code of Conduct ("Code") (xxxxx.xxx/xxxxxxxxxxxxxxx) and Behavior Guidelines for the NCYC (“Guidelines”) (xxxxx.xxx/xxxxxxxxxxxx). I understand it is my legal duty to review and explain Code and Guidelines to my child prior to signing this Agreement. I agree that if my child fails in any way to abide by Code or Guidelines, my child can be dismissed from NCYC and sent home immediately with no right of reimbursement or refund for any amount in connection therewith from NFCYM et al. or Diocese et al. Initials of Parent/Guardian Youth: As a participant in NCYC, I agree to conform to the NFCYM Youth Participant Code of Conduct (xxxxx.xxx/xxxxxxxxxxxxxxx) and Behavior Guidelines for the NCYC (xxxxx.xxx/xxxxxxxxxxxx). I also understand and agree that my parent/guardian will be notified of any infractions requiring my dismissal from NCYC, and I will be sent home at my parent's/guardian's expense. Among other things, being found with any alcoholic beverages, drugs, or weapons is cause for automatic dismissal from NCYC. Initials of Youth NCYC Fee Nonrefundable: I agree that if my child suffers an illness requiring dismissal from NCYC, there is accident or emergency requiring dismissal of my child from NCYC, my child commits an infraction of Code, or if NCYC must be discontinued in event of accident or emergency, my child must return home at my expense, and I assume the risk of any loss of any nonrefundable or additional costs associated with travel and fees for NCYC, with no right of reimbursement or refund for any amount in connection with therewith from NFCYM et al. or the Diocese et al. Insurance: NFCYM urges you to purchase travel or other insurance to cover the risks you have assumed under this Legal Agreement. Please indicate below:   🞏 YES, I have purchased a travel or other insurance package to manage any risks I may experience by attending NCYC. 🞏 NO, I knowingly declined to purchase an insurance package and acknowledge that I declined this risk management opportunity. I fully understand the consequences of and sign this LEGAL AGREEMENT - GENERAL RELEASE, COVENANT NOT TO SUE, LIABILITYWAIVER, AND PERMISSION AGREEMENT knowingly, freely, and willingly. If any provisions of this Agreement shall be held to be invalid or unenforceable for any reason, the remaining provisions shall continue to be valid and enforceable. I understand this Legal Agreement must be printed then signed by hand. Failure to notarize does not diminish legal validity of this Legal Agreement. A typed name does not constitute a signature. Signature of Parent or Guardian Date Signature of Youth Date NOTARY (Mandatory only if Required by Diocesan Policy) City/County of ; State of On this day of , 2019, before me personally appeared the adult named xxxxxxxxxxx, who is personally known to me or produced positive identification, and who executed the foregoing LEGAL AGREEMENT – GENERAL RELEASE, COVENANT NOT TO SUE, LIABILITY WAIVER, AND PERMISSION AGREEMENT, and acknowledged that s/he executed the same as her/his free act and deed. [NOTARIAL SEAL] Signature of Notary Public: My commission expires:: NFCYM, Inc. (7/19)

Parent/Guardian. I agree to instruct my child to abide by all rules and regulations as outlined by NFCYM, particularly the Youth Participant Code of Conduct ("Code") (xxxxx.xxx/xxxxxxxxxxxxxxx) and Behavior Guidelines for the NCYC (“Guidelines”) (xxxxx.xxx/xxxxxxxxxxxx). I understand it is my legal duty to review and explain Code and Guidelines to my child prior to signing this Agreement. I agree that if my child fails in any way to abide by Code or Guidelines, my child can be dismissed from NCYC and sent home immediately with no right of reimbursement or refund for any amount in connection therewith from NFCYM et al. or Diocese et al. Initials of Parent/Guardian Youth: As a participant in NCYC, I agree to conform to the NFCYM Youth Participant Code of Conduct (xxxxx.xxx/xxxxxxxxxxxxxxx) and Behavior Guidelines for the NCYC (xxxxx.xxx/xxxxxxxxxxxx). I also understand and agree that my parent/guardian will be notified of any infractions requiring my dismissal from NCYC, and I will be sent home at my parent's/guardian's expense. Among other things, being found with any alcoholic beverages, drugs, or weapons is cause for automatic dismissal from NCYC. Initials of Youth NCYC Fee Nonrefundable: I agree that if my child suffers an illness requiring dismissal from NCYC, there is accident or emergency requiring dismissal of my child from NCYC, my child commits an infraction of Code, or if NCYC must be discontinued in event of accident or emergency, my child must return home at my expense, and I assume the risk of any loss of any nonrefundable or additional costs associated with travel and fees for NCYC, with no right of reimbursement or refund for any amount in connection with therewith from NFCYM et al. or the Diocese et al. Insurance: NFCYM urges you to purchase travel or other insurance to cover the risks you have assumed under this Legal Agreement. Please indicate below:   🞏 YES, I have purchased a travel or other insurance package to manage any risks I may experience by attending NCYC. 🞏 NO, I knowingly declined to purchase an insurance package and acknowledge that I declined this risk management opportunity. I fully understand the consequences of and sign this LEGAL AGREEMENT - GENERAL RELEASE, COVENANT NOT TO SUE, LIABILITYWAIVER, AND PERMISSION AGREEMENT knowingly, freely, and willingly. If any provisions of this Agreement shall be held to be invalid or unenforceable for any reason, the remaining provisions shall continue to be valid and enforceable. I understand this Legal Agreement must be printed then signed by hand. Failure to notarize does not diminish legal validity of this Legal Agreement. A typed name does not constitute a signature. Signature of Parent or Guardian Date Signature of Youth Date NOTARY (Mandatory only if Required Not required by Diocesan Policythe Diocese of Springfield in Illinois) City/County of ; State of On this day of , 2019, before me personally appeared the adult named xxxxxxxxxxx, who is personally known to me or produced positive identification, and who executed the foregoing LEGAL AGREEMENT – GENERAL RELEASE, COVENANT NOT TO SUE, LIABILITY WAIVER, AND PERMISSION AGREEMENT, and acknowledged that s/he executed the same as her/his free act and deed. [NOTARIAL SEAL] Signature of Notary Public: My commission expires:

Parent/Guardian. I have been informed of the Clinic-Based Mental Health Services procedures for verifying income and expenses information. I agree to instruct my child to abide by all rules and regulations as outlined by NFCYM, particularly the Youth Participant Code of Conduct ("Code") (xxxxx.xxx/xxxxxxxxxxxxxxx) and Behavior Guidelines supply any documentation requested for the NCYC (“Guidelines”) (xxxxx.xxx/xxxxxxxxxxxx)verification purposes. I understand that I am responsible for paying the actual cost of the services received each month, or sliding fee scale cost, unless payment is made by a third-party payor for any service delivered that month. I understand that it is my responsibility to inform the Clinic-Based Mental Health Services if my family experiences a significant change in our financial circumstance that may impact the sliding fee scale calculation. I understand that Clinic-Based Mental Health Services are required to access any and all private, state, and federal financial support for services delivered. I understand that I am not obligated to allow Clinic-Based Mental Health Services to bill my family's private insurance company for professional services provided to my child/family. I may choose to pay the entire costs without insurance coverage. I UNDERSTAND THAT NON-PAYMENT OF ALL FEES WILL NOT RESULT IN THE SUSPENSION OF SERVICES SUBJECT TO A COST SHARE. MY CONSENT IS VOLUNTARY AND MAY BE WITHDRAWN AT ANY TIME. Written notification must be provided to Clinic-Based Mental Health Services. Client/Parent/Guardian Signature (Firma del padre o tutor legal/cliente) * Date (Fecha) Sign Receipt & Acknowledgement Notice (Recibo y Confirmación de Aviso) Patient/Client Name (Nombre del paciente o cliente) * Date of Birth (Fecha de nacimiento) * DISD Student ID (Num. de DISD) I hereby acknowledge that I have received and have been given an opportunity to read a copy of the Dallas Independent School District’s Notice of Privacy Practices. The Notice of Privacy Practices has been explained to me, and I have had the opportunity to have my questions about the Notice answered, if applicable. I understand if I have further questions regarding the Notice or regarding my privacy rights, I can contact the District’s Executive Director, Dr. Xxxxxx Xxxxx, at Dallas Independent School District, Youth and Family Centers, 0000 X. Xxxxxxx Xxxxxxxxxx, Xxx 000, Xxxxxx, Xxxxx, 00000, (000)000-0000 (phone), (000)000-0000 (fax), or email: xxxxxxxx@xxxxxxxxx.xxx (mailto:xxxxxxxx@xxxxxxxxx.xxx). Signature (Firma) * Date Date will be captured on form submission Legal Authority If you are signing as a personal representative of an individual, please describe your legal duty authority to act for this individual (parent, guardian, power of attorney, etc.) Si está firmando como un representante personal de un individuo, por favor describa su autoridad legal para actuar por este individuo (padre, tutor legal, poder de representación, etc.). Submit Sign Exhibit C Registration and Consents for Treatment Forms Agreement for Confidentiality FERPA The Family Educational Rights and Privacy Act, 20 U.S.C. 1232g, (FERPA) is a federal law that protects the privacy interests of parents and students with regard to education records. It affects every public elementary and secondary school, including A+ Charter Schools. XXXXX defines “education records” broadly to include all records, files, documents, and materials, such as films, tapes, or photographs, containing information directly related to a student that an education agency or institution (such as A+ Charter Schools) maintains. For example, education records include information that A+ Charter Schools maintains on students in report cards, surveys and assessments, health unit records, special education records, and correspondence between the school and other entities regarding students. FERPA restricts the release of education records or information from education records that could identify the student (“personally identifiable information”). Before releasing such records or information to a party outside the school system, the school must obtain consent of the student’s parent unless the student is 18 or over, in which case only the student can consent to the release, or unless the release falls under one of the exceptions to the consent requirement. Statutory exceptions applicable to the prior consent requirement are set forth in detail under Section 99.31 of the FERPA regulations in Part 34 of the Code of Federal Regulations. A common exception is a disclosure made to other school officials who have a legitimate educational interest in the information. A school official includes a person or company with whom the District has contracted to perform special task. A school official has a legitimate educational interest if the official needs to review an education record in order to fulfill his or her professional responsibilities. As an independent contractor for A+ Charter Schools or entity who has contracted with A+ Charter Schools to perform a special task, if you receive confidential student information or education records about a student as part of fulfillment of your professional responsibilities to A+ Charter Schools, you and/or your company must not disclose the information you receive to anyone who does not have a legitimate educational interest. Furthermore, you are to seek guidance from the person to whom you report to or work with at A+ Charter Schools before releasing student record information in any part. My signature below indicates that Foremost Family Health Centers has read and explain Code understood the information and Guidelines to my child prior to signing expectations set forth above. Foremost Family Health Centers shall comply with FERPA and ensure those who work for it listed below on a project for A+ Charter Schools are aware of this Agreement and comply with this Agreement. I agree that if my child fails in any way Authorized signature: Chief Executive Officer Date Authorization to abide by Code or Guidelines, my child can be dismissed from NCYC and sent home immediately with no right of reimbursement or refund for any amount in connection therewith from NFCYM et al. or Diocese et al. Initials of Parent/Guardian Youth: As a participant in NCYC, I agree to conform to the NFCYM Youth Participant Code of Conduct (xxxxx.xxx/xxxxxxxxxxxxxxx) and Behavior Guidelines for the NCYC (xxxxx.xxx/xxxxxxxxxxxx). I also understand and agree that my parent/guardian will be notified of any infractions requiring my dismissal from NCYC, and I will be sent home at my parent's/guardian's expense. Among other things, being found with any alcoholic beverages, drugs, or weapons is cause for automatic dismissal from NCYC. Initials of Youth NCYC Fee Nonrefundable: I agree that if my child suffers an illness requiring dismissal from NCYC, there is accident or emergency requiring dismissal of my child from NCYC, my child commits an infraction of Code, or if NCYC must be discontinued in event of accident or emergency, my child must return home at my expense, and I assume the risk of any loss of any nonrefundable or additional costs associated with travel and fees for NCYC, with no right of reimbursement or refund for any amount in connection with therewith from NFCYM et al. or the Diocese et al. Insurance: NFCYM urges you to purchase travel or other insurance to cover the risks you have assumed under this Legal Agreement. Please indicate below:   YES, I have purchased a travel or other insurance package to manage any risks I may experience by attending NCYC. NO, I knowingly declined to purchase an insurance package and acknowledge that I declined this risk management opportunity. I fully understand the consequences of and sign this LEGAL AGREEMENT - GENERAL RELEASE, COVENANT NOT TO SUE, LIABILITYWAIVER, AND PERMISSION AGREEMENT knowingly, freely, and willingly. If any provisions of this Agreement shall be held to be invalid or unenforceable for any reason, the remaining provisions shall continue to be valid and enforceable. I understand this Legal Agreement must be printed then signed by hand. Failure to notarize does not diminish legal validity of this Legal Agreement. A typed name does not constitute a signature. Signature of Parent or Guardian Date Signature of Youth Date NOTARY (Mandatory only if Required by Diocesan Policy) City/County of ; State of On this day of , 2019, before me personally appeared the adult named xxxxxxxxxxx, who is personally known to me or produced positive identification, and who executed the foregoing LEGAL AGREEMENT – GENERAL RELEASE, COVENANT NOT TO SUE, LIABILITY WAIVER, AND PERMISSION AGREEMENT, and acknowledged that s/he executed the same as her/his free act and deed. [NOTARIAL SEAL] Signature of Notary Public: My commission expires:Release Medical Information MEDICAL RECORDS MANUAL

Parent/Guardian. I agree to instruct my child to abide by all rules and regulations as outlined by NFCYM, particularly the Youth Participant Code of Conduct ("Code") (xxxxx.xxx/xxxxxxxxxxxxxxx) and Behavior Guidelines for the NCYC (“Guidelines”) (xxxxx.xxx/xxxxxxxxxxxx). I understand it is my legal duty to review and explain Code and Guidelines to my child prior to signing this Agreement. I agree that if my child fails in any way to abide by Code or Guidelines, my child can be dismissed from NCYC and sent home immediately with no right of reimbursement or refund for any amount in connection therewith from NFCYM et al. or Diocese et al. Initials of Parent/Guardian Youth: As a participant in NCYC, I agree to conform to the NFCYM Youth Participant Code of Conduct (xxxxx.xxx/xxxxxxxxxxxxxxx) and Behavior Guidelines for the NCYC (xxxxx.xxx/xxxxxxxxxxxx). I also understand and agree that my parent/guardian will be notified of any infractions requiring my dismissal from NCYC, and I will be sent home at my parent's/guardian's expense. Among other things, being found with any alcoholic beverages, drugs, or weapons is cause for automatic dismissal from NCYC. Initials of Youth NCYC Fee Nonrefundable: I agree that if my child suffers an illness requiring dismissal from NCYC, there is accident or emergency requiring dismissal of my child from NCYC, my child commits an infraction of Code, or if NCYC must be discontinued in event of accident or emergency, my child must return home at my expense, and I assume the risk of any loss of any nonrefundable or additional costs associated with travel and fees for NCYC, with no right of reimbursement or refund for any amount in connection with therewith from NFCYM et al. or the Diocese et al. Insurance: NFCYM urges you to purchase travel or other insurance to cover the risks you have assumed under this Legal Agreement. Please indicate below:   YES, I have purchased a travel or other insurance package to manage any risks I may experience by attending NCYC.  NO, I knowingly declined to purchase an insurance package and acknowledge that I declined this risk management opportunity. I fully understand the consequences of and sign this LEGAL AGREEMENT - GENERAL RELEASE, COVENANT NOT TO SUE, LIABILITYWAIVER, AND PERMISSION AGREEMENT knowingly, freely, and willingly. If any provisions of this Agreement shall be held to be invalid or unenforceable for any reason, the remaining provisions shall continue to be valid and enforceable. I understand this Legal Agreement must be printed then signed by hand. Failure to notarize does not diminish legal validity of this Legal Agreement. A typed name does not constitute a signature. Signature of Parent or Guardian Date Signature of Youth Date NOTARY (Mandatory only if Required by Diocesan Policy) City/County of ; State of On this day of , 2019, before me personally appeared the adult named xxxxxxxxxxx, who is personally known to me or produced positive identification, and who executed the foregoing LEGAL AGREEMENT – GENERAL RELEASE, COVENANT NOT TO SUE, LIABILITY WAIVER, AND PERMISSION AGREEMENT, and acknowledged that s/he executed the same as her/his free act and deed. [NOTARIAL SEAL] Signature of Notary Public: My commission expires:: NFCYM, Inc. (7/19) Diocese of Superior August 2016 Permission Form for Minors with Indemnity Agreement and Emergency Contacts Child Information Full Name: Date of Birth: Gender: Female Male Address: Home parish name & city: Current Grade: T-Shirt Size: Event Information Description of Event: National Catholic Youth Conference (NCYC) – Indianapolis, IN – Xxxxx Oil Stadium. Includes general sessions, workshops addressing a variety of topics, opportunities for reconciliation, daily Mass, Eucharistic adoration, prayer, talks, sacraments, education, recreation, music, dancing, etc. Date of Event: November 21 – 23, 2019 Begin time: 11 pm Wednesday End time: 7pm Sunday (approximation) Transportation Method: Chartered buses Participant cost: $615 per person (includes, bus, conference, hotel, three breakfasts and t-shirt. Non refundable, but transferrable.) Sponsored by: Diocese of Superior, Office of Catholic Formation Supervised by: Xxxxxxxxxxx Xxxxxxxxx Your permission is needed for your child to participate in the event listed above. Please return this signed form no later than to . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - I give permission for my child to participate in the above named event. My signature below indicates that I understand the risks and hazards associated with the event this event, including injury, illness and the rare possibility of death. I understand that I may discuss any concerns or questions I have about this event with a representative of the parish or Diocese of Superior prior to giving permission for my child to participate. In consideration for my child’s participation, I agree to reimburse and indemnify the above named parish and the Diocese of Superior for all reasonable legal and court fees incurred by the parish/diocese in defending a lawsuit that I or my child may bring against the parish/diocese which relates to the above named event if the parish/diocese is found not legally liable by the courts and prevails in the lawsuit. If the parish/diocese is found legally liable for any injuries sustained by my child, this paragraph will not apply. I further agree to reimburse the diocese or any other agency for property damage or any bodily harm to other participants caused by my child. Parent/guardian signature: Date: Relationship to child: Phone numbers – Home: Work: Cell: Parents’ email address: EMERGENCY CONTACTS Name: Relationship: Phone – Home: Cell: Work: Name: Relationship: Phone – Home: Cell: Work: Xxxxx’s primary physician: Phone: Health system & location: Health insurance carrier: Policy number: A MEDICATION CONSENT FORM MUST BE COMPLETED AND THE PRODUCT SUPPLIED FOR EACH MEDICATION YOUR CHILD WILL NEED TO TAKE DURING THIS EVENT. ASK THE EVENT ORGANIZER FOR THIS FORM. (two sided form) Code of Conduct