Activity: Bổn Mạng Miền Tây Date/Time: Saturday, October 13th, 2012 from 10: 30am-11pm Location

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Phong Trào Thiếu Nhi Thánh Thể Việt Nam Tại Hoa Kỳ

The Vietnamese Eucharistic Society, Western USA

Đoàn Kitô Vua, Sacramento/ St. Joseph School
Permission Slip / Voluntary Activities Participation Form
Activity: Bổn Mạng Miền Tây

Date/Time: Saturday, October 13th, 2012 from 10:30am-11pm

Location: Trung Tâm Công Giáo Việt Nam

2849 South White Road, San Jose CA 95148

If Student/Participate is a minor, then parent or guardian must sign. If Student/Participate is an adult, no signature of parent or guardian is required. A signed VOLUNTARY ACTIVITIES PARTICIPATION FORM must be on file with the Local Church/Diocese before a Student/Participate will be allowed to participate in this Activity.
I, the undersigned (Print name)___________________________ (Student/Participate) wish to participate in the Đại Hội Hiệp Sĩ I, Knight of Eucharist Convention activity of the Vietnamese Eucharistic Society, USA (VEYS). IF UNDER 18 YEARS, my parent or guardian authorizes my participation in this activity.
I understand and acknowledge that this Activity may be dangerous and hazardous and, by its very nature pose the potential risk of severe and serious physical and emotional injury/illness, or even death, to all individuals who participate in such Activity.
I understand and acknowledge that in order to participate in this Activity I agree to ASSUME ALL LIABILITY AND RESPONSIBILITY for any and all potential risk, injuries, or even death which may be associated with participation in such Activity. I represent and warrant that the Student/Participate is mentally and physically fit, capable, able, and willing to participate in such Activity without any limitations.
I understand, acknowledge, and agree that the VEYS, its trustees, employees, agents, coaches, teachers, volunteers, or representatives shall not be liable for any illness/injury suffered by Student/Participate which is incident to and/or associated with preparing for and/or participating in this Activity.
I hereby release, discharge, indemnify, and agree to hold harmless VEYS, VEY’s governing board (Board), and each of their trustees, employees, agents, coaches, teachers, volunteers, and representatives free from any and all liability arising out of or in connection with Student/Participant’s participation in this Activity, including all related activity such as games, practices, training, activities, trips, and related exercise. For purpose of this release, liability means all claims, demands, losses, causes of action, suits, or judgments of any kind that Student/Participant or Student/Participant’s parents, guardians, heirs, executors, administrators, and assigns may have against VEYS, Board, and their trustees, employees, agents, teachers, volunteers, coaches, and representatives because of Student/Participant’s personal, physical, or emotional, injury, accident, illness, or death, or because of any loss of or damage to property that occurs to Student/Participant or his/her property during Student/Participant's participation in the Activity that may result form any cause including but not limited to VEYS’, Boards’, trustees’, employees’, agents’, coaches’, teachers’, volunteers’, or representatives’ own passive or active negligence or other acts other than fraud, willful misconduct or violation of the law.
I acknowledge that I have carefully read this VOLUNTARY ACTIVITIES PARTICIPATION FORM and that I understand that potential dangers incident to engaging in the Activity, am fully aware of the legal consequences of this agreement, and agree to its terms and understand I am waiving certain rights and assuming the risk of damage from my participation in the Activity.
Student/Participant UNDER 18 YEARS
___________________________ ______________________________ _____________

Parent/Guardian Full Name (print) Parent Guardian Signature Date

Student/Participant 18 YEARS and ABOVE
____________________________ ______________________________ _____________

Student/Participant Full Name (print) Student/Participant Signature Date

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