Location of Camp: St. Teresa of Calcutta Parish, Monches; Holy Hill Basilica, Hubertus; Ice Age Trails - Holy Hill route
Supervisor: Fr. John LoCoco
Type of Event: Outdoor hiking; indoor Mass and prayer
Date: Saturday, April 1, 2023; 9 a.m. - 3:30 p.m.
Transportation: Parents drop-off/pick-up

I consent to the participation of my SON /WARD in the above named ACTIVITY.
In consideration for my SON /WARD’s participation, I agree to reimburse and indemnify St. Francis de Sales
Seminary (understood to include the Archdiocese of Milwaukee) for all reasonable legal and court fees incurred by St. Francis de Sales Seminary in defending a lawsuit that I or my SON /WARD may bring against St. Francis de Sales
Seminary which relates to the above named ACTIVITY if St. Francis de Sales Seminary is found not legally liable by the
courts and prevails in the lawsuit. If St. Francis de Sales Seminary is found legally liable for injuries sustained by
SON/WARD, 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 my SON/WARD will be participating in. I further understand that I had the opportunity to fully
discuss this agreement with a representative of St. Francis de Sales Seminary to clarify any concerns or questions about
the ACTIVITY or this agreement that I may have had.

I hereby consent that any still or electronic image and/or audio recording, in which I or my child may appear, may be used by the Archdiocese of Milwaukee Vocation Office
parish/school and/or by the Archdiocese of Milwaukee. I understand that these materials are being used for the promotion of Camp de Sales. The images and/or recordings may be used to support recruitment, fundraising, evangelization and other communication efforts.

I release the staff and volunteers and I understand and agree that the use of my picture is not an invasion of privacy. Neither I, nor anyone claiming to be speaking on my behalf will later object to the Archdiocese’s use of this/these photographs.

MEDICAL MATTERS: I hereby warrant to the best of my knowledge, my child is in good health, and I
assume all responsibility for the health of my child. OF THE FOLLOWING STATEMENTS pertaining to
medical matters. SIGN ONLY THOSE IN ACCORDANCE WITH YOUR WISHES.

Emergency Medical Treatment: In the event of an emergency, I hereby give permission to transport my child to a hospital for
emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the
event of an emergency, if you are unable to reach me at the above numbers, contact the emergency contact listed.

Other Medical Treatment: In the event it comes to the attention of DESIGNATED SUPERVISOR or
staff that my SON/WARD becomes ill with symptoms of headache, vomiting, sore throat, fever, or diarrhea, I DO want to be called.

Over-the counter medication: Any over–the-counter medication, such as: aspirin, ibuprofen, Tylenol, cough drops, etc must come from home. No over-the-counter medications will be dispensed to SON/WARD.

Medications: If my SON/WARD is taking medications at present and will bring the medication in the original container, and only the number of doses necessary for the duration of this activity. I give permission for SON/WARD to take this medication on his/her own.