Raging Waves

Youth #1 First and Last Name
Youth #1 Cell Pone
Youth #2 First and Last Name
Youth #2 Cell Phone
Youth #3 First and Last Name
Youth #3 Cell Phone
Address
City

Parent Name
Parent Email
Parent cellphone number
Emergency name and number if parent can't be reached

: Insurance Information in case of emergency
Policy in the name of:
Insurance Company
Policy Number
Name of Physician
Physician phone number
Authorization: By checking this box, I agree on behalf of myself, my heirs, assigns, executors, and personal representatives, to hold harmless and defend Maternity BVM Catholic Church and the Diocese of Joliet, its officers, directors, agents, employees, or representatives from any and all liability for illness or death arising from or in connection with my participation in this event.
Medical Authorization: By checking this box I grant permission for the administration of First Aid to my child (participant listed above) by the people in charge of the event and those transporting my child to and from the event as their judgement deems advisable and to make the necessary referrals to qualified physicians for the treatment of illness or accidents of a more serious nature. I understand I will be promptly notified in the event of any serious illness or accident and prior to any major surgery, except when delay of such communication would endanger life. In the case of a medical emergency, I understand that every effort will be made to contact the parent/guardian of the participant. In the event that I cannot be reached I hereby give permission to the physicians selected by the adult staff to hospitalize, secure proper treatment for and to order injections, anesthesia or surgery if deemed necessary for my child. Please indicate any current medical conditions and/or medication allergies above.
Code of Behavior: By checking this box I acknowledge that I am representing our diocese/parish during this event, and I will represent us well. I will adhere to all Diocesan Guidelines and display responsible, mature, and respectful behavior in my words, actions, and usages.
Expectations: 1. All participants are expected to arrive on time. 2. All participants are expected to demonstrate respect and common courtesy at all times. Inappropriate language/behavior/conduct will not be tolerated. 3. Socializing should always be done in public areas. 4. Dress should reflect the values of modesty and respect, and inscriptions and images on clothing should reflect Christian values. 5. The possession or consumption of any alcoholic beverages is prohibited. 6. The possession of any illegal substances is prohibited and subject to legal action. 7. Smoking, vaping, e-cigarettes, smokeless tobacco, and cannabis in any form are prohibited. 8. Weapons and/or drug paraphernalia are prohibited. INFRACTION OF THESE RULES CAN MEAN IMMEDIATE DISMISSAL WITH NO REFUND
Further Expectations: I understand and agree to the Code of Behavior. I also understand and agree that at the time of an infraction requiring my dismissal my guardians (if under the age of 18) will be notified and/or I will be responsible for any and all costs related to the participants dismissal from activities and any all costs assessed by local authorities.
Use of Photographs/Videos for Marketing Purposes Permissions: Videos and or/photos may be taken during this event. By checking this box I give permission to use the participants image in video and/or photos which may be used for future promotional efforts.
Payment: I understand that payment must be made before the deadline for a spot to be reserved for your youth and if your youth needs to cancel his/her participation for any reason, that this event is non-refundable.

: Do not forget to click on "Submit" below

Earn a $5 discount for each shift you work at the MBVM Garage Sale!

GARAGE SALE SIGN UP HERE!

Click Here to Make Payment

Raging Waves

Insurance Information in case of emergency

Do not forget to click on "Submit" below

Are You Still Working?

Your session has expired