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Release of liability and parental authorization of minors – Pilgrimage 2017

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

This form takes about 2 minutes 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:
      1. The express permission of your spouse, if registered for pilgrimage;
      2. The express permission of the parents AND the guardians on pilgrimage of any minor you have registered; and,
      3. 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.

    and middle initial
    If none, enter zeros.
    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 2017 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 2017.

    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 end of this form.

    We, the undersigned, residing at:
    ,
    authorize the "National Coalition of Clergy & Laity" to make all necessary arrangements for any surgical or urgent hospitalization for our child/children:
    ,
    and/or in our absence place all or said child/children, in the care of Mr./Mrs./Rev.
    ,
    residing at:
    ,
    who is/are participating in the same Pilgrimage 2017 events as our child/children.

    Guardian/s

    Parent 1

    Parent 2

    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.

    Pilgrimage for Restoration

    2018 A.D.

    — 23rd annual —

    Friday – Sunday
    28-30 September

    A traditional walking pilgrimage

    from the Lake of the Blessed Sacrament
    at Lake George Village, NY

    to the Shrine of Our Lady’s Martyrs of New France
    at Auriesville, NY

    Come to restore. The rest will come.