CVBC 2024 All Aboard the Jesus Express

Father's First and Last Name REQUIRED Please fill out this field. Please enter valid data.

Mother's First and Last Name REQUIRED Please fill out this field. Please enter valid data.

Email REQUIRED Please fill out this field. Please enter an email address.

Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Home or Cell Phone #1 REQUIRED Please fill out this field. Please enter valid data.

Home or Cell Phone #2 REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact / Relationship REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Phone Number REQUIRED Please fill out this field. Please enter valid data.

Medical Doctor / Phone Number REQUIRED Please fill out this field. Please enter valid data.

Children REQUIRED Please fill out this field.
Child 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Age REQUIRED Please fill out this field. Please enter valid data.
- Finishing Grade REQUIRED Please fill out this field. Please enter valid data.
- Medical or Allergy Concerns
- Permission Slip:
  Basilica of St. Mary of the Angels , Olean, NY
  The undersigned do hereby release, forever discharge and agree to hold harmless The Diocese of Buffalo and the Basilica of St. Mary of the Angles Parish from and against any and all liability, claim, demands, lawsuits, and expenses of any kind whatsoever which may be incurred or suffered by the undersigned and/or participant while attending the above listed events.
  
  The undersigned further agree to indemnify and hold The Diocese of Buffalo and the Basilica of St. Mary of the Angels and its respective members, directors, employees, and agents (collectively the “indemnities) harmless from and against any and all claims, demands, actions, lawsuits, and liabilities, including attorney fees, and expenses, and costs sustained by the Indemnities as a result of negligent, willful or intentional acts of the undersigned and/or participant (if participant is 18 or under).
  
  Parent: I hereby give permission to the Basilica of St. Mary of the Angels Parish and its respective staff and adult volunteers to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not limited to emergency surgery and I (we) fully and completely assume all responsibility for all medical bills. Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise I (we) assume all responsibility and transportation costs. This authorization also permits my youth to receive such treatment only after such a reasonable effort has been made to reach me. Further, should it be necessary for all participants to return home due to medical reasons, disciplinary action or otherwise, I (we) assume all responsibility and transportation costs. As well I am aware of the rules and responsibilities that my son or daughter is expected to uphold and respect.
  
  I understand my son(s)/daughter(s) photopgraph and/or likeness may be used in a future promotion by the Basilica of St. Mary of the Angels and Morning Star Family Holy Hour.
  
  I Agree to the permission slip information. Please select this field.
Child 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Age REQUIRED Please fill out this field. Please enter valid data.
- Finishing Grade REQUIRED Please fill out this field. Please enter valid data.
- Medical or Allergy Concerns
- Permission Slip:
  Basilica of St. Mary of the Angels , Olean, NY
  The undersigned do hereby release, forever discharge and agree to hold harmless The Diocese of Buffalo and the Basilica of St. Mary of the Angles Parish from and against any and all liability, claim, demands, lawsuits, and expenses of any kind whatsoever which may be incurred or suffered by the undersigned and/or participant while attending the above listed events.
  
  The undersigned further agree to indemnify and hold The Diocese of Buffalo and the Basilica of St. Mary of the Angels and its respective members, directors, employees, and agents (collectively the “indemnities) harmless from and against any and all claims, demands, actions, lawsuits, and liabilities, including attorney fees, and expenses, and costs sustained by the Indemnities as a result of negligent, willful or intentional acts of the undersigned and/or participant (if participant is 18 or under).
  
  Parent: I hereby give permission to the Basilica of St. Mary of the Angels Parish and its respective staff and adult volunteers to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not limited to emergency surgery and I (we) fully and completely assume all responsibility for all medical bills. Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise I (we) assume all responsibility and transportation costs. This authorization also permits my youth to receive such treatment only after such a reasonable effort has been made to reach me. Further, should it be necessary for all participants to return home due to medical reasons, disciplinary action or otherwise, I (we) assume all responsibility and transportation costs. As well I am aware of the rules and responsibilities that my son or daughter is expected to uphold and respect.
  
  I understand my son(s)/daughter(s) photopgraph and/or likeness may be used in a future promotion by the Basilica of St. Mary of the Angels and Morning Star Family Holy Hour.
  
  I Agree to the permission slip information. Please select this field.
Child 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Age REQUIRED Please fill out this field. Please enter valid data.
- Finishing Grade REQUIRED Please fill out this field. Please enter valid data.
- Medical or Allergy Concerns
- Permission Slip:
  Basilica of St. Mary of the Angels , Olean, NY
  The undersigned do hereby release, forever discharge and agree to hold harmless The Diocese of Buffalo and the Basilica of St. Mary of the Angles Parish from and against any and all liability, claim, demands, lawsuits, and expenses of any kind whatsoever which may be incurred or suffered by the undersigned and/or participant while attending the above listed events.
  
  The undersigned further agree to indemnify and hold The Diocese of Buffalo and the Basilica of St. Mary of the Angels and its respective members, directors, employees, and agents (collectively the “indemnities) harmless from and against any and all claims, demands, actions, lawsuits, and liabilities, including attorney fees, and expenses, and costs sustained by the Indemnities as a result of negligent, willful or intentional acts of the undersigned and/or participant (if participant is 18 or under).
  
  Parent: I hereby give permission to the Basilica of St. Mary of the Angels Parish and its respective staff and adult volunteers to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not limited to emergency surgery and I (we) fully and completely assume all responsibility for all medical bills. Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise I (we) assume all responsibility and transportation costs. This authorization also permits my youth to receive such treatment only after such a reasonable effort has been made to reach me. Further, should it be necessary for all participants to return home due to medical reasons, disciplinary action or otherwise, I (we) assume all responsibility and transportation costs. As well I am aware of the rules and responsibilities that my son or daughter is expected to uphold and respect.
  
  I understand my son(s)/daughter(s) photopgraph and/or likeness may be used in a future promotion by the Basilica of St. Mary of the Angels and Morning Star Family Holy Hour.
  
  I Agree to the permission slip information. Please select this field.
Child 4
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Age REQUIRED Please fill out this field. Please enter valid data.
- Finishing Grade REQUIRED Please fill out this field. Please enter valid data.
- Medical or Allergy Concerns
- Permission Slip:
  Basilica of St. Mary of the Angels , Olean, NY
  The undersigned do hereby release, forever discharge and agree to hold harmless The Diocese of Buffalo and the Basilica of St. Mary of the Angles Parish from and against any and all liability, claim, demands, lawsuits, and expenses of any kind whatsoever which may be incurred or suffered by the undersigned and/or participant while attending the above listed events.
  
  The undersigned further agree to indemnify and hold The Diocese of Buffalo and the Basilica of St. Mary of the Angels and its respective members, directors, employees, and agents (collectively the “indemnities) harmless from and against any and all claims, demands, actions, lawsuits, and liabilities, including attorney fees, and expenses, and costs sustained by the Indemnities as a result of negligent, willful or intentional acts of the undersigned and/or participant (if participant is 18 or under).
  
  Parent: I hereby give permission to the Basilica of St. Mary of the Angels Parish and its respective staff and adult volunteers to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not limited to emergency surgery and I (we) fully and completely assume all responsibility for all medical bills. Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise I (we) assume all responsibility and transportation costs. This authorization also permits my youth to receive such treatment only after such a reasonable effort has been made to reach me. Further, should it be necessary for all participants to return home due to medical reasons, disciplinary action or otherwise, I (we) assume all responsibility and transportation costs. As well I am aware of the rules and responsibilities that my son or daughter is expected to uphold and respect.
  
  I understand my son(s)/daughter(s) photopgraph and/or likeness may be used in a future promotion by the Basilica of St. Mary of the Angels and Morning Star Family Holy Hour.
  
  I Agree to the permission slip information. Please select this field.
Child 5
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Age REQUIRED Please fill out this field. Please enter valid data.
- Finishing Grade REQUIRED Please fill out this field. Please enter valid data.
- Medical or Allergy Concerns
- Permission Slip:
  Basilica of St. Mary of the Angels , Olean, NY
  The undersigned do hereby release, forever discharge and agree to hold harmless The Diocese of Buffalo and the Basilica of St. Mary of the Angles Parish from and against any and all liability, claim, demands, lawsuits, and expenses of any kind whatsoever which may be incurred or suffered by the undersigned and/or participant while attending the above listed events.
  
  The undersigned further agree to indemnify and hold The Diocese of Buffalo and the Basilica of St. Mary of the Angels and its respective members, directors, employees, and agents (collectively the “indemnities) harmless from and against any and all claims, demands, actions, lawsuits, and liabilities, including attorney fees, and expenses, and costs sustained by the Indemnities as a result of negligent, willful or intentional acts of the undersigned and/or participant (if participant is 18 or under).
  
  Parent: I hereby give permission to the Basilica of St. Mary of the Angels Parish and its respective staff and adult volunteers to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not limited to emergency surgery and I (we) fully and completely assume all responsibility for all medical bills. Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise I (we) assume all responsibility and transportation costs. This authorization also permits my youth to receive such treatment only after such a reasonable effort has been made to reach me. Further, should it be necessary for all participants to return home due to medical reasons, disciplinary action or otherwise, I (we) assume all responsibility and transportation costs. As well I am aware of the rules and responsibilities that my son or daughter is expected to uphold and respect.
  
  I understand my son(s)/daughter(s) photopgraph and/or likeness may be used in a future promotion by the Basilica of St. Mary of the Angels and Morning Star Family Holy Hour.
  
  I Agree to the permission slip information. Please select this field.
Child 6
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Age REQUIRED Please fill out this field. Please enter valid data.
- Finishing Grade REQUIRED Please fill out this field. Please enter valid data.
- Medical or Allergy Concerns
- Permission Slip:
  Basilica of St. Mary of the Angels , Olean, NY
  The undersigned do hereby release, forever discharge and agree to hold harmless The Diocese of Buffalo and the Basilica of St. Mary of the Angles Parish from and against any and all liability, claim, demands, lawsuits, and expenses of any kind whatsoever which may be incurred or suffered by the undersigned and/or participant while attending the above listed events.
  
  The undersigned further agree to indemnify and hold The Diocese of Buffalo and the Basilica of St. Mary of the Angels and its respective members, directors, employees, and agents (collectively the “indemnities) harmless from and against any and all claims, demands, actions, lawsuits, and liabilities, including attorney fees, and expenses, and costs sustained by the Indemnities as a result of negligent, willful or intentional acts of the undersigned and/or participant (if participant is 18 or under).
  
  Parent: I hereby give permission to the Basilica of St. Mary of the Angels Parish and its respective staff and adult volunteers to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not limited to emergency surgery and I (we) fully and completely assume all responsibility for all medical bills. Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise I (we) assume all responsibility and transportation costs. This authorization also permits my youth to receive such treatment only after such a reasonable effort has been made to reach me. Further, should it be necessary for all participants to return home due to medical reasons, disciplinary action or otherwise, I (we) assume all responsibility and transportation costs. As well I am aware of the rules and responsibilities that my son or daughter is expected to uphold and respect.
  
  I understand my son(s)/daughter(s) photopgraph and/or likeness may be used in a future promotion by the Basilica of St. Mary of the Angels and Morning Star Family Holy Hour.
  
  I Agree to the permission slip information. Please select this field.
Child 7
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Age REQUIRED Please fill out this field. Please enter valid data.
- Finishing Grade REQUIRED Please fill out this field. Please enter valid data.
- Medical or Allergy Concerns
- Permission Slip:
  Basilica of St. Mary of the Angels , Olean, NY
  The undersigned do hereby release, forever discharge and agree to hold harmless The Diocese of Buffalo and the Basilica of St. Mary of the Angles Parish from and against any and all liability, claim, demands, lawsuits, and expenses of any kind whatsoever which may be incurred or suffered by the undersigned and/or participant while attending the above listed events.
  
  The undersigned further agree to indemnify and hold The Diocese of Buffalo and the Basilica of St. Mary of the Angels and its respective members, directors, employees, and agents (collectively the “indemnities) harmless from and against any and all claims, demands, actions, lawsuits, and liabilities, including attorney fees, and expenses, and costs sustained by the Indemnities as a result of negligent, willful or intentional acts of the undersigned and/or participant (if participant is 18 or under).
  
  Parent: I hereby give permission to the Basilica of St. Mary of the Angels Parish and its respective staff and adult volunteers to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not limited to emergency surgery and I (we) fully and completely assume all responsibility for all medical bills. Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise I (we) assume all responsibility and transportation costs. This authorization also permits my youth to receive such treatment only after such a reasonable effort has been made to reach me. Further, should it be necessary for all participants to return home due to medical reasons, disciplinary action or otherwise, I (we) assume all responsibility and transportation costs. As well I am aware of the rules and responsibilities that my son or daughter is expected to uphold and respect.
  
  I understand my son(s)/daughter(s) photopgraph and/or likeness may be used in a future promotion by the Basilica of St. Mary of the Angels and Morning Star Family Holy Hour.
  
  I Agree to the permission slip information. Please select this field.
Child 8
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Age REQUIRED Please fill out this field. Please enter valid data.
- Finishing Grade REQUIRED Please fill out this field. Please enter valid data.
- Medical or Allergy Concerns
- Permission Slip:
  Basilica of St. Mary of the Angels , Olean, NY
  The undersigned do hereby release, forever discharge and agree to hold harmless The Diocese of Buffalo and the Basilica of St. Mary of the Angles Parish from and against any and all liability, claim, demands, lawsuits, and expenses of any kind whatsoever which may be incurred or suffered by the undersigned and/or participant while attending the above listed events.
  
  The undersigned further agree to indemnify and hold The Diocese of Buffalo and the Basilica of St. Mary of the Angels and its respective members, directors, employees, and agents (collectively the “indemnities) harmless from and against any and all claims, demands, actions, lawsuits, and liabilities, including attorney fees, and expenses, and costs sustained by the Indemnities as a result of negligent, willful or intentional acts of the undersigned and/or participant (if participant is 18 or under).
  
  Parent: I hereby give permission to the Basilica of St. Mary of the Angels Parish and its respective staff and adult volunteers to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not limited to emergency surgery and I (we) fully and completely assume all responsibility for all medical bills. Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise I (we) assume all responsibility and transportation costs. This authorization also permits my youth to receive such treatment only after such a reasonable effort has been made to reach me. Further, should it be necessary for all participants to return home due to medical reasons, disciplinary action or otherwise, I (we) assume all responsibility and transportation costs. As well I am aware of the rules and responsibilities that my son or daughter is expected to uphold and respect.
  
  I understand my son(s)/daughter(s) photopgraph and/or likeness may be used in a future promotion by the Basilica of St. Mary of the Angels and Morning Star Family Holy Hour.
  
  I Agree to the permission slip information. Please select this field.

CVBC 2024 All Aboard the Jesus Express

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