Militia Immaculata

As parent/legal guardian of the participant names above, I give my permission to participate fully in Militia Immaculata on Wednesdays from September 17, 2025 to May 27, 2026 at 3:15 p.m.-4:00 p.m. I agree to indemnify and hereby release the Most Reverend Michael F. Burbidge Bishop of the Catholic Diocese of Arlington and his successors in office, as well as the Catholic Diocese of Arlington and all Diocesan clergy, employees, volunteers, and participating parishes and schools from any and all liability, claims, demands for personal injury, sickness and death, as well as property damage and expenses of any nature whatsoever which may be incurred by the undersigned of the participant resulting from said participant’s involvement in the above mentioned event (including transportation to and from the event). Furthermore, I on behalf of the participant hereby assume all risk of personal injury, sickness, death, damage, and expenses resulting from said participant’s involvement in the above described event.

As the parent of the above mentioned youth, I hereby grant permission for my youth to be medically treated in case of sickness or accident. I understand and acknowledge that participation in the activities involves inherent risks of injury to my youth. I agree to indemnify the Parish, Youth Ministers, Volunteers and the Diocese of Arlington for any costs or expenses arising out of my youth’s participation in the activities including the cost of any medical care given my youth or any expenses or fees incurred in any lawsuit arising as a result of any damage or injuries caused by my child in the course of his/her participation in the activity. I further give my consent to 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 have not been given a guarantee as to the results of examination or treatment. I authorize the hospital or medical facility to dispose of any specimen or tissue taken from the above named minor.

By clicking “I agree” and participating in any of the youth program’s various activities, events, volunteer opportunities, etc., I authorize Holy Spirit Youth Ministry to use my youth’s picture or video recording for social/advertising purposes to include but not limited to the parish website, parish social media, and bulletin boards on church grounds.

I understand that all Youth Ministry activities are “technology free”. This includes meetings, adventures and travel to and from those adventures. I agree to share this policy with my youth and will assist in seeing that he/she respect the policy. It is best the youth leave their cell phones and ipods at home or in the car. In the event they arrive with their phones, we will ask them to hand them over until the end of the meeting. While we will make every attempt to keep their devices secure, we will not be responsible if they are lost are stolen. Youth will have free access to use the chaperones phones or the office phones if they feel the need, no questions asked.

For All Youth: I agree to present myself in a respectable manner – no inappropriate clothing (midriffs, tees with inappropriate slogans, etc) I agree to behave respectfully toward all others – be kind to your peers, don’t harass others, keep your hands to yourself, obey all chaperones, listen politely during meetings. No cursing. I agree to abide by the stated rules of the games we play, following the directives of the chaperones and maintaining good sportsmanship. I understand that if I violate the Code of Conduct, I will be asked to leave the meeting at that time and will not be permitted to attend the next meeting/activity. Parents agree to pick up their youth should it be requested of them.