Adult Mentor Application for VBS

LIABILITY AGREEMENT: I request permission for myself to attend this event to be held at St. Joseph Church. I understand this event will take place under the guidance and supervision of responsible Parish employees/volunteers and, if needed, give permission for myself to be evaluated, diagnosed, treated /medicated in accordance with standard medical practice by licensed medical personnel. I relieve the Parish, Diocese, and volunteer leaders of all responsibility and consequences that may arise because of this treatment. I will not hold the Parish, Diocese, or representative associated with this event responsible in the event of injury. In case of an emergency, I give permission for the Parish coordinators to act on my behalf. Further, I agree to accept any and all financial responsibility related to such care.

I agree to abide by all the rules as outlined in the Diocese of Portland Code of Behavior/Ethics.* The Diocese of Portland will not be liable if I fail to cooperate with said rules and any infractions may result in immediate dismissal from this event. I understand that I am legally responsible for my behavior.

DIGITAL RELEASE:  I hereby grant to the Diocese of Portland my consent without reservation to use, assign, convey, reproduce, copyright or publish my name, voice, image, and/or likeness that arises from my participation in this event, whether still or motion pictures, audio or video tape, for promotional, instructional, business or any other lawful purposes, at the Diocese of Portland’s sole discretion.