I understand that the Catholic Diocese of Springfield in Illinois and Totus Tuus assume no responsibility for accidents which may occur in association with diocesan events and activities. I agree to use my/our personal insurance to cover any such incidents. I understand that, in the event medical intervention is needed, every attempt will be made to contact the persons listed above. In the event those individuals cannot be reached, I/We hereby give permission to the physician or any other qualified medical staff selected by the event leader to hospitalize, secure medical treatment, and/or order injection, anesthesia, or surgery for Participant as deemed necessary.

Does this participant have any allergies or other medical conditions that might affect this person’s ability to fully participate in the Totus Tuus program? 
(If yes, please describe)

I understand all reasonable safety precautions will be taken at all times by the Catholic Diocese of Springfield in Illinois and Totus Tuus and its employees and agents during the events and activities. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree to indemnify and hold harmless the Catholic Diocese of Springfield in Illinois and Totus Tuus, its leaders, employees and volunteer staff from any and all claims arising from or in connection with attending this event.

Please initial below.