November Lifeline: Mercy First: Encountering God's Love in the Sacraments
Event Address: 110 Crusader Ave. W, West St Paul, MN 55118
Group Leader: Gabriel Leahy - (651)-313-8591 or gabriel.leahy@stjosephcommunity.org
Saturday November 5th, 2022
6-9:30pm 
Transportation: Meet at event
Student/Participant's Name *
Date of Birth *
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Gender *
Grade *
Parent/Guardian's Name *
Home Address *
Parent's Best Email  *
Parent's Best Phone Number *
Emergency Contact Name *
Emergency Contact Phone Number *
Emergency Contact's Relationship to Minor *
Are you Able to Chaperone this event? *
AUTHORIZATION, CONSENT AND RELEASE FOR USE OF VISUAL LIKENESSES AND ORIGINAL WORKS

I grant the following rights to the St. Joseph Parish and School and and the Archdiocese of Saint Paul and Minneapolis:

1. The right to use all photographs, pictures, portraits, vocal sounds, appearances/likeness, video, and performance (hereinafter collectively known as "image") of my child in the possession of the St. Joseph Parish and School.

2. The right to use, reproduce, publish, exhibit, distribute, and transmit the image of my child individually or in conjunction with other images or printed matter in the production of brochures, slides, motion picture, broadcasts (radio, television, and other social and digital media), audio or video files, recordings, still photography, CD-ROM and any other manner now known or later developed.

3. The right to use, reproduce, publish, exhibit, distribute, and transmit the image of my child individually or in conjunction with other images or printed matter on St. Joseph Parish and School and the Archdiocese of Saint Paul and Minneapolis's internet websites. No home address or phone number will be published

4. The right to record, reproduce, amplify, edit, and simulate my child's image and all sound effects produces.

5. The right to copyright, in the name of St. Joseph Parish and School and the Archdiocese of Saint Paul and Minneapolis, works that contain the image of my child. 

6. The right to use and publish for general communication, advertising, commercial or publicity purposes, or for any other lawful purpose whatsoever my original work.

7. The right to assign the above-mentioned rights to third parties without notice to me

I understand that video files, still photos, or other media incorporating the image of me will become the property of St. Joseph Parish and School. I herby waive the right to inspect or approve the image or any finished materials that incorporate the image.

I understand and agree that no compensation will be provided, now or in the future, in connection with the use of my child's image or my original work.

I hereby release, discharge, and agree to indemnify and hold harmless the St. Joseph  Parish and School, the Archdiocese of Saint Paul and Minneapolis, and their agents, employees and assigns from any and all claims, demands, right, and cases of action of whatever kind that I have or may have or may arise by reason of this authorization and from the use of my child's image and original work, including but not limited to, all claims for libel and invasion of privacy.

This consent regarding my likens and original work is valid until such time as I choose to rescind this authorization and consent. If I choose to rescind this authorization and consent, I agree that I will contact St. Joseph Parish and School in writing and that my rescission will not take effect until it is receives by St. Joseph Parish and School. I understand and acknowledge that it may not be possible to recall any work or photos that have been published prior to receipt of my written rescission

I hereby Authorize and consent that St. Joseph Parish and School and the Archdiocese of Saint Paul and Minneapolis have the right to use my name  (and my child's name) in connection with their educational, promotional fund-raising activities, or for any other legitimate purpose.

I HAVE READ THE ABOVE AUTHORIZATION, CONSENT AND RELEASE FOR USE OF VISUAL LIKENESS AND ORIGINAL WORKS, ITS DISCLOSURES, AUTHORIZATIONS, AND RELEASES. I UNDERSTAND AND AGREE I HAVE HAD THE OPPPORTUNITY TO CONSIDER THE TERMS AND UNDERSTAND THEM. BY SELECTING "YES, I AGREE", I UNDERSTAND AND AGREE I AM VOLUNTARILY ACCEPTING THE PROVISIONS WITH FULL KNOWLEDGE OF THE SIGNIFICANCE.
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I understand and agree that as parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above names minor ("Student/Participant"). Further, I hereby warrant that to the best of my knowledge, my child is in good health and I assume all responsibility for the health of my child
I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend St. Joseph Parish and School, its officers, directors, employees and agents, and the Archdiocese of Saint Paul and Minneapolis, its employees and agents chaperones, or representatives associated with the event and activities (hereinafter "releases"), from any claim, including but not limited to all claims relating to communicable disease, arising rom or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate Releases for reasonable attorney's fees and expanses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of Releases.
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Agreement and Signature
By my signature below, I acknowledge and agree this electronic or digital signature is the legally binding equivalent to my handwritten signature. This electronic or digital signature has the same validity and meaning as my handwritten signature. Further, by my signature below, as parent/guardian, I acknowledge and agree to all the terms, conditions above.

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