• Dear Parent or Legal Guardian:

Your son/daughter is scheduled to participate in a parish-sponsored activity. This activity will take place under the guidance and supervision of Mrs. Adalene Noll, Coordinator of Parish Religious Formation at Saint Theresa Parish.

Name of CHILD attending FIRST EUCHARIST Retreat

CONSENT AND WAIVER

I hereby request participation of my child in the event described above. I understand that it will take place on the parish grounds and that my child will be under the supervision of the designated parish employee/volunteer on the stated dates.

I hereby agree, on behalf of the named student and his/her other parent or legal guardians, to waive any claims for liability against this parish, the Diocese of Harrisburg (and any diocesan or parish officers, agents, or employees) which may arise from the participation of the named student in the above-described event. 

By typing your name below, you understand that you are electronically signing this document and are agreeing to all the policies, terms, and conditions set forth above.

Parent's name:

I have diocesan youth protection clearances and can help on the day of the retreat.