Lead Missionary Info


Adult Liability & Medical Information

Consent to Participate & Indemnity Agreement

I consent to participate in Love Begins Here Milwaukee. I agree to reimburse and indemnify the parish (understood to include the Archdiocese of Milwaukee) for all reasonable legal and court fees incurred by parish in defending a lawsuit that I may bring against the parish which relates to Love Begins Here if the parish is found not legally liable by the courts and prevails in the lawsuit. If the parish is found legally liable for injuries sustained by me, this paragraph will not apply. 

I certify that I have an understanding of this agreement and any risks and hazards associated with the activity described above that I will be participating in. I further understand that I had the opportunity to fully discuss this agreement with a representative of the parish or Love Begins Here to clarify any concerns or questions about the activity or this agreement that I may have had.

By entering my full name, I attest that this constitutes my legal electronic signature on this form. 

Medical Information & Consent

The following information will be used only in the event of an emergency in which you are unable to seek medical attention for yourself.

Special dietary needs, allergies, or mental/physical health issues we should know in the event of an emergency:

I am taking medication and will bring all such medications necessary, and medications will be well labeled.

Emergency Medical Treatment 

In the event of an emergency, I hereby give permission to be transported to a hospital for emergency medical treatment. I wish to have my spouse/parent advised prior to any further treatment by the hospital or doctor. In the event of emergency, please contact:

I hereby warrant that to the best of my knowledge, I am in good health and I assume all responsibility for my health.

By entering my full name, I attest that this constitutes my legal electronic signature on this form.


Safe Environment Training

All Lead Missionaries must participate in a safe environment training session, be subject to a state and national criminal background check by their parish, and read and sign a code of ethical standards and mandatory reporting statement, before beginning their service.


Driver & Vehicle Information

Lead Missionaries drive teen missionaries throughout the week. As such, each Lead Missionary must have a reliable vehicle to use throughout the week, submit to a driver check, have sufficient insurance coverage, and complete Safe Driver training.

Driver & Insurance Information

If you have not completed this course, please contact your parish group leader for further instructions.

Vehicle that will be used

Driving Record

If the answer to any of the above questions is yes, you are not an approved driver until your driving record has been reviewed and approved by Catholic Mutual. 

Certification

I certify that the information given on this form is true and correct to the best of my knowledge. I understand that as a volunteer/employee driver, I must be 23 years of age or older, hold a valid driver's license, have no physical disability that may impair my ability to drive safely, and have the required insurance coverage in effect on any vehicle used to transport students. I understand that my driver record on file with the Wisconsin Department of Transportation may be requested and reviewed. 

By entering my full name, I attest that this constitutes my legal electronic signature on this form.

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