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Waiver and Release of All Claims for Minor

Name of Minor Child:

Group or Retreat Name:

Arrival Date:

General Liability

As the guardian of the minor child as identified above, I recognize and acknowledge that there are certain risks of physical injury inherent in his/her activities on property owned by St. Mary of Providence Center, and I agree to assume (subject to the limitation in the third paragraph below) the full risk of any injuries, including death, damages or loss which the minor child as identified above may sustain as a result of participating in any and all activities connected with use of this property.

I hereby waive and relinquish all claims I may have against St. Mary of Providence Center, and its officers, agents, employees and volunteers as a result of my use of their property except for claims that may arise because of the sole negligence, gross negligence or willful and wanton misconduct of St. Mary of Providence Center or its officers, legal representatives, agents or employees.

I further agree to indemnify, hold harmless and defend St. Mary of Providence Center, its officers, agents, employees and volunteers from any and all claims resulting from injuries including death, damages and losses sustained by the minor child as identified above and arising out of, connected with, or in any way associated with my activities on their property except for claims that may arise because of the sole negligence, gross negligence, or willful and wanton misconduct of St. Mary of Providence Center or its officers, legal representatives, agents or employees. This agreement also pertains to the individuals who are invited by the minor child as identified above onto the property owned by St. Mary of Providence Center.

Liability in regard to COVID-19

I, the parent/guardian of the minor child as identified above, understand that In regard to COVID-19 and/or its variants and hereafter, and as much as is reasonably possible, all persons using the St. Mary of Providence Center premises will be personally responsible for demonstrating safety and sanitation practices according to the norms required by local health authorities at the time of their stay. I understand that, while all precautions will be taken, it is impossible to guarantee the prevention of germs or viruses and the possibility of contracting germs and viruses. By executing this Release all participants understand the potential risks associated with participating in the retreat and are voluntarily electing to participate with knowledge of the potential risks. Therefore, in consideration for making the arrangements and providing this retreat I hereby release and hold harmless the group sponsoring the retreat or program as well as St. Mary of Providence Center, and all their agents, employees and representatives from any and all liability in connection with COVID-19 and/or its variants or other health issues which may affect my son or daughter as a result of this trip.

As guardian of the minor child as identified above, I have read and fully understand this.

Parent or Guardian Name:

Address:

Phone:

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Signed by Sister Brenda McHugh
Signed On: 2025-03-15

Timestamp

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2025-02-15 9:21 am EDT

{{esig_forminator_field_id-date-1}} Minor Waiver and Release Uploaded by Sister Brenda McHugh - waivers@stmaryprov.org IP 99.115.30.26

2025-03-14 11:35 pm EDT

Document owner accounting@stmaryprov.org has handed over this document to waivers@stmaryprov.org 2025-03-14 23:35:16 - 99.115.30.26