Urban Immersion Mission Trip Waiver - Episcopal Diocese of San Diego Urban Immersion Mission Trip Waiver - Episcopal Diocese of San Diego

Urban Immersion Mission Trip Waiver

The Way - Service Pilgrimage Youth Waiver with Conduct Code

Release of Liability for The Way - Service Pilgrimage Youth Event

I acknowledge and agree that:
1. By virtue of my participation I risk serious bodily injury.
2. I knowingly and freely assume all such risk.
3. I allow my child to be transported by chaperones to offsite locations as required in the trip schedule.
4. I (we), the undersigned parent(s)/guardian(s) do release, hold harmless and promise not to sue The Episcopal Diocese of San Diego, St. Bartholomew’s, St.Andrew's, Pacific Beach and their officers, agents, employees and chaperones, with respect to any and all such injury, except that injury or loss which results from the gross negligence or willful or wanton misconduct of one of those individuals or organizations.
5. I will inform my child that he/she must follow all safety rules and instructions or directions given during participation in the event, and that my child’s failure to follow instructions may result in my obligation to retrieve my child if requested. My child and I (we) realize that participation in the trip is voluntary.

Filming and Photo Release for Children

I hereby grant to the Episcopal Diocese of San Diego and to its employees, agents, assignees, and chaperones the right to photograph and film my dependent and use the photo and/or film or other digital reproduction of him/her or other reproduction of his/her physical likeness for publication processes, whether electronic, print, digital or electronic publishing via the internet. The youth will not be identified by name.

I certify that I am a custodial parent or legal guardian and have the aforementioned rights to assign.

Authorization for Medical Treatment of a Minor

In accordance with California Family Code Section 6910, I (we) give authorization to a physician or surgeon, licensed under the provisions of the Medical Practice Act, for our child to receive care and/or emergency medical treatment when necessary. I understand that every attempt will be made to contact me should such a situation arise. I understand and agree that any expenditure incurred for the care and transportation of the above named minor is my responsibility.

Code of Conduct

The following standards enumerate the manner in which young people participating in church-related activities should conduct themselves for everything and everyone whom they come into contact.

 I will not possess or use illegal drugs, alcohol, tobacco, or carry weapons of any kind.
 I will follow all schedules, rules, guidelines and emergency procedure plans of the program and facility. This includes such as curfew, cell phone use, check-in, and not going off site.
 I will report any emergencies, concerns and safety issues immediately to adult leaders or chaperones.
 I will socialize only in public areas prior to curfew. No visiting is permitted in sleeping rooms occupied by members of the opposite sex.
 I will follow directives from adult leaders or chaperones.
 I will behave in a manner as not to hurt anyone verbally, emotionally, physically or sexually.
 I will refrain from using profanity.
 I will behave in a manner as to not put down, ridicule or make fun of another person. I will use my words and actions to lift people up.
 I will be on time and participate in all planned activities.
 I will wear a seatbelt and follow safe travel procedures when traveling.
 I will work towards making the event a good and safe time for everyone.

We have read, and agree to comply with the code of conduct. We understand that breaking the code of conduct will result in a parent to come and pick me up from the event.