Join us for our annual

Lock In
on September 19 - 20.

Doors open at 6 pm, Saturday and ends 9 am, Sunday.

#FRIENDSHIP #BBQ #FREE TIME #MASS #PRAYER

#GAMES #RELATIONSHIP BUILDING #FUN

#REFLECTION

#CHILL

#MUSIC #ICE BREAKERS

Menu:
Saturday Dinner: Hamburgers and hot dogs.
Sunday Breakfast: Assortment of cereals
Snacks and drinks: Chips, water, soda, and juice
Things to remember:
*Sleeping bag and toiletries
*Forms and
$25
fees are due September 12, 2015 at Saint Cecilia Rectory (2555 17th ave,
SF, CA 94116) Andrew Aquino
*Food, drink, and dress shoes are prohibited in the pavilion.Tennis shoes only
*Any special accommodations feel free to email
scyouthminister@gmail.com
or call me
(415) 235-6799

SaintCeciliaYouthGroupLockIn
ParentalReleaseForm
MustbeturnedinbySeptember12,2015

LastName:____________________________FirstName:_____________________________

Waiver and Release Form: In consideration of the acceptance of my sons/daughterapplication

for participation in the event described herein, I hereby grant permission for my adolescent to
participate in the event and, to the extent permitted by law, waive, release and discharge any
andallclaimsfordamagesfordeath,personalinjury,lossorpropertydamagewhich Imayhave
or which may hereafter accrue to me or my adolescent as a result of my child'sparticipationin
the event or activity described herein, including but not limited to transportationtoandfromthe
event or activity, whether or not caused by the negligence (active or passive) of the
Archdiocese. This Waiver and Release is intended to release and discharge in advance the
promoters, sponsors, officials, leaders and the ROMAN CATHOLIC ARCHBISHOP OF SAN
FRANCISCO, A CORPORATION SOLE AND ST. CECILIA PARISH, and theirofficers,agents,
and employees from any and all liability arising out of or connected in any way with my child's
participationin:
SCYGLockInunderthesupervisionofAndrewAquinofromSeptember19
20,2015.TheeventwillstartSaturday6pmandendSunday9am.
Also, I hereby attest and verify that my son/daughter is physically fitorcapableof participation
in this event, and further, my adolescent's physical condition for safe participation in this
abovedescribed event or activity has been verified by alicensedmedicaldoctorduringthelast
six(6)months.
I agree to inform my son/daughter to abide by the rules established by the promoters,
sponsors, officials or leaders of the event or activity, and to obey thedirectionsgivenbyanyof
them. Further, I hereby waive any and all rights to any photographs, videotapes, motion
pictures, recording, or any other record of this event or activity, which may be made by the
Archbishop/Parish/Agency and affiliate organizations. Further, I hereby attest that my
adolescent's participation in this event or those activities will be conducted on his/herowntime
and not on his/her employer's time, that this is for his/her own personal benefit, and any injury
sustainedwillnotbeconsideredbymyselformyheirsorassignsasaworkincurredinjury.
This Waiver and Release form is signed in order to participate in this eventoractivityformy
son's/daughters own personal enjoyment and benefit, and isdonesofreelywith fullknowledge
oftherisksanddangersincidentthereto:

_______________________________________________________________________
ParentsName(Print)
Parentsphonenumberincaseofemergency

________________________________________
SignatureofParent
Date

Person(s)(otherthanparents)tonotifyincaseofemergency:

Name__________________________________Phone________________________________

HealthPlanCarrier______________________________Policy#________________________