Mater Dei Catholic High School
PERMISSION TO PARTICIPATE IN OFF CAMPUS ACTIVITY EXCULPATORY RELEASE and IDEMNITY AGREEMENT -and-AUTHORIZATION FOR EMERGENCY MEDICAL AND DENTAL TREATMENT PERMISSION
When: Friday, December 9, 2022Meet Time: 12:25 PM at Fatima Court. Busses will leave at 1:15 PM.Arrive Time:
Approximately 3:45 PM.Game Time: 4:00 - approximately 7:00 PM.Return Time:
Approximately 9:00 PM. Students must be picked up at MDCHS within 15 minutes of when we return.Where: Saddleback College - 28000 Marguerite Parkway, Mission Viejo, California 92692Reminder:
Lunch will be available for purchase at school prior to getting on the bus. Students will not have time to leave campus to get food and come back before the busses leave
Pre-Order your lunch before 9:00 am on Friday @ https://cafemdchs.com
Students should bring money to purchase food at the game.All students who sign up to go on the bus must come back on the bus. No exceptions.
The undersigned parent(s) or legal guardian(s) of
a student at MATER DEI CATHOLIC HIGH SCHOOL (hereafter “MDCHS”), hereby grant(s) permission for him/her to participate in off campus activity as follows:
and further consent(s) that he/she may be transported to such activity in a private automobile operated by an adult or student volunteer or by public or chartered bus.
IT IS UNDERSTOOD that adult supervision of the off campus activity will be under the direction of MDCHS and its staff, and the mandatory conditions for volunteer student drivers are: a valid California Drivers License; parent permission to operate the automobile to transport other students; the automobile to be driven is in good operating condition; car pool insurance - $250,000/$500,000 bodily injury and $25,000 property damage; and only the correct number of students are to be in the vehicle. This means ONE STUDENT PER SEAT BELT. Transporting students in the back of a pick-up is NOT ALLOWED.
RELEASE & INDEMNITY
In consideration for the above student being permitted to participate in the off campus activity specified above, the undersigned agree(s) to not make or join in a claim or civil suit for injury, death or property damage against an entity affiliated with the CATHOLIC DIOCESE OF SAN DIEGO, including MDCHS, their administrators, staff or volunteers participating in the above off campus activity and hereby release(s) all entities affiliated with the CATHOLIC DIOCESE OF SAN DIEGO, including MDCHS, and their administrators, staff and volunteers from all actions, claims and demands the undersigned or the student may hereafter have for injury, death or property damage arising out of negligence or strict liability, as consistent with public policy, arising out of participation in the off campus activity specified above.
Further, if a claim or civil suit is made by the student or someone in a representative capacity on behalf of the student for injury, death or property damage, arising out of participation in the off campus activity specified above, the undersigned agree(s) to indemnify and hold harmless all entities affiliated with the CATHOLIC DIOCESE OF SAN DIEGO, including MDCHS, their administration, staffs or volunteers, from any and all such claims, suits, damages, including judgments and /or settlements, whether such claims arise out of the negligence of any such entity or affiliated individual, whether an employee, agent or volunteer, and whether such negligence is active or passive and whether individually or in concert with others.
The undersigned as parent(s) or legal guardian(s) of the above named minor student hereby authorize and grant to the supervising or participating adult permission in the event of illness or injury while participating in the off campus activity specified above to consent to the following:
Any X-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care to be rendered to the minor under the general or special supervision and upon the advise of a physician and surgeon licensed under the provisions of the Medical Practice Act or to consent to an X-ray examination, anesthetic, dental or surgical diagnosis or treatment and hospital care to be rendered to the minor by a dentist licensed under the provisions of the Dental Practice Act.
Said, authorization to include the release of any medical or dental records to the attending physician or dentist for review.