We do hereby release and forever discharge the Diocese of Greensburg, Pennsylvania; Mother of Sorrows Church, Murrysville and designated employees and volunteers from any/all actions or suits in law or equity which we might hereafter have by reasons of injuries sustained by our son/daughter participating in the above-mentioned activity. In case of emergency, we give permission for our child to be treated at a hospital and/or by a medical doctor.

We hereby grant to the Diocese of Greensburg, Pennsylvania; Mother of Sorrows Church, Murrysville and its respective licensees, successors and assigns, the right and permission, with respect to those photographs taken of me or the minor named below on whose behalf I am signing, and with respect to any printed or electronic matter in connection therewith, to do the following: 1. To include such photographs on the Diocese of Greensburg website, on print material, and parish advertisements. 2. To use my name, or the name of the minor on whose behalf I am signing, in connection with the foregoing.

I hereby release, discharge and agree to indemnify and hold harmless the Diocese of Greensburg, Pennsylvania; Mother of Sorrows Church, Murrysville and its legal representatives, licensees, successor and assigns, from all claims and demands whatsoever arising out of or in connection with the foregoing, and waive any right to inspect or approve the same.

In the event of any emergency, I give authority to the accompanying adults to authorize treatment. I understand that an attempt to notify me will be made before any treatment is authorized.

Please sign below.