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.
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 2022 at their own risk. "National Coalition of Clergy & Laity" (NCCL), its officers, members, employees, and volunteer organizers are not in any way liable or responsible for any injury, illness (including but not limited to COVID-19), death, or other mishap incurred or suffered by any pilgrim at any time or in any part of Pilgrimage for Restoration 2022.
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.
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./Miss/Rev., also demanding of the same children to show respect for & to obey the instructions, directives, and commands of adult pilgrim-organizers.
who is/are participating in the same Pilgrimage 2022 events as our child/children.
IMPORTANTRelease 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.