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 16, 2026 to May 26, 2027 at 3:15 p.m.-4:15 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 or 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.

Militia Immaculata is a prayerful and welcoming environment. Children are expected to treat one another and adult leaders with respect, participate appropriately in prayer and activities, and follow the directions of our adult leaders. Parents may be contacted if a child’s behavior makes it difficult for the group to continue safely or prayerfully.