Release of liability and parental authorization of minors – Pilgrimage 2020

If you are human, leave this field blank.

Who must fill out this form, and why? Click here for the answer.

This form takes about a minute to complete - a minute or two longer, if also authorizing one or more minors.

At the top of this page we ask for your name & contact information.
After that we ask for your 'release of liability' and for the 'authorization of minor children', if any -- whether your own, or those of a parent who is sending them on pilgrimage, and who have registered with you.
Before you begin, please have on hand the following:

The express permission of your spouse, if registered for pilgrimage;
The express permission of the parents AND the guardians on pilgrimage of any minor you have registered; and,
The postal & e-mail addresses of parents and guardians, as well as their phone & mobile numbers.

To submit parental authorization for minors accompanying you from more than one family, you must fill out a separate form for each family.

All fields marked * are required.

my first name *

and middle initial

my last name *

age *

address *

city *

state / province *

zip / postal code *

e-mail *

phone *

If none, enter zeros.

mobile phone *

If none, enter zeros.

RELEASE OF LIABILITY

To be signed electronically below by ALL adult pilgrims and/or parents of minor pilgrims.

All pilgrims participate and walk in the Pilgrimage for Restoration 2020 at their own risk. "National Coalition of Clergy & Laity" and/or volunteer organizers are not liable or responsible for any injury, illness, death or other mishap incurred or suffered by any pilgrim at any time or in any part of Pilgrimage for Restoration 2020.

I / We, the undersigned, residing at the above- and below-entered addresses, click the check-box to the left in agreement to the Release of Liability statement here above, and thereby release NCCL and pilgrimage organizers from all liability to/for myself/ourselves and/or the named children/minors in our charge.

date *

pilgrim 1 - or parent not making pilgrimage *

pilgrim 2 -- only if spouse of pilgrim 1

e-mail address of pilgrim 2

PARENTAL AUTHORIZATION OF MINOR CHILDREN

This section must be completed if parents/guardians will be allowing minors to participate in the pilgrimage.

If not, click "no" below. Then go directly to the "Submit" button below, at the very bottom of this form.

Are any minor children participating in the pilgrimage? *

Yes

We, the undersigned, residing at:

(address) ,

authorize the "National Coalition of Clergy & Laity" to make all necessary arrangements for any surgical or urgent hospitalization for our child/children:

(names of children) ,

and/or in our absence place all or said child/children, in the care of Mr./Mrs./Miss/Rev., also demanding of the same children to show respect for & to obey the instructions, directives, and commands of adult pilgrim-organizers.

(names of guardian/s on pilgrimage) ,

residing at:

(address of guardian/s on pilgrimage) ,

who is/are participating in the same Pilgrimage 2020 events as our child/children.

Guardian/s

name - Guardian 1

e-mail Guardian 1

mobile - Guardian 1

name - Guardian 2

e-mail Guardian 2

mobile - Guardian 2

Parent 1

name of Parent 1

e-mail Parent 1

phone - Parent 1

date

Parent 2

name of Parent 2

e-mail Parent 2

phone - Parent 2

date

IMPORTANT
Release of liability is not transmitted until
you click on the "Submit" button below.

Having trouble with the form? E-mail the webmaster. Or phone 610/435-2634.

reCAPTCHA