I, hereby represent that: I am in good health and in proper physical condition to participate in the 2023 High School Youth Ministry Mission Trip on 6/15/2024 – 6/23/2024 (Event), and I am not under the influence of any prescription drugs which would in any way impair my ability to safely participate in the Event.

I agree to advise you immediately of any changes in my health or medical condition that might affect my participation in the event in any way. I agree that it is my sole responsibility to determine whether I am sufficiently fit and healthy enough to participate in the Event.

I am aware that I am voluntarily participating in these activities of home improvement, which include, but are not limited to, demolition, home repair, construction, loading and unloading materials, painting, plumbing, electrical, use of tools including power tools, use of ladders, transporting to and from building sites, and other related activities, with the knowledge of the danger involved. I hereby agree to accept any and all risks of injury.

I hereby represent that I am covered by a medical insurance policy providing emergency care and that information regarding that policy has been provided.

I do hereby, for myself, my heirs, executors, and administrators, waive, release, absolve indemnify, and agree to hold harmless any and all adults who chaperone these weekends, also DOT Ministries, Inc. and its respective representatives, successors, supervisors, sponsors, organizers, and participants for any injuries in connection with the 2024 High School Youth Ministry Mission Trip on 6/15/2024 – 6/23/2024 that is sponsored by DOT Ministries, Inc. I likewise release from any liability any person transporting myself to and from any of the activities. I hereby grant permission for the publication of group (two or more persons) photos taken at this event.

I also give permission to seek any emergency care should I be incapacitated as a result of being involved in an accident or be injured in any way during such events named above. I understand that in any such instance, all attempts will be made to contact the emergency contact listed below. In the event that such emergency contact cannot be reached, I hereby give permission to the attending physician to hospitalize, secure treatment for, and order injection, anesthesia, and/or surgery should I become incapacitated.

I also agree that I am legally responsible for all/any personal actions during this event and agree that I am financially responsible for any/all damages, legal fees, and other costs incurred as a result of my actions/behavior.

I acknowledge that my signature on the bottom of this page signifies that I am in agreement with all the statements on this form. Furthermore, I agree to abide by all policies and expectations regarding adult leaders/chaperones as put forth by DOT Ministries, Inc. My primary function on this trip is to ensure the safety and well-being of all participants in my charge. I will refrain from any actions/behaviors that are not consistent with the teachings of the Catholic Church and any that could be potentially harmful to myself and any other participants.