Include legal parents/guardians, PLUS all adults authorized to pick up child(ren) during Vacation Bible School on June 26-30, 2023.

In case of emergency and the parent/guardian cannot be reached, please contact:

I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend Vacation Bible School, St. Jude's Discovery Center Preschool, St. Jude of the Lake - Mahtomedi, MN, Church of St. Pius X - White Bear Lake, MN, and the Archdiocese of Saint Paul and Minneapolis, their officers, volunteers, directors, employees, chaperones, coaches, agents, and representatives (hereinafter “Releasees”),  associated with the Vacation Bible School 2023 events and activities from any claims, including but not limited to all claims relating to communicable disease, arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate Releasees for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage.

This form allows you, the parent or guardian, to identify if images of your child and their original works may be used for purposes of print, online, social media communication and promotion. I am the parent or legal guardian of the minor(s) listed above. (“My Child”). I grant the following rights to St. Jude's Discovery Center Preschool, St. Jude of the Lake, Church of St. Pius X, and the Archdiocese of Saint Paul and Minneapolis: 1. The right to use all photographs, pictures, portraits, vocal sounds, appearances/likenesses, video and performances (hereinafter collectively known as “image”) of My Child in the possession of St. Jude of the Lake. 2. The right to use, reproduce, publish, exhibit, distribute, and transmit the image of My Child individually or in conjunction with other images or printed matter in the production of brochures, slides, motion pictures, broadcasts (radio, television, and other social and digital media), audio or video files, recordings, still photography, CD-Rom and any other manner of media now known or later developed; 3. The right to use, reproduce, publish, exhibit, distribute, and transmit the image of My Child individually or in conjunction with other images or printed matter on St. Jude's Discovery Center Preschool, St. Jude of the Lake, Church of St. Pius X, and the Archdiocese of Saint Paul and Minneapolis’s Internet websites. No home address or phone number will be published; 4. The right to record, reproduce, amplify, edit, and simulate My Child’s image and all sound effects produced; 5. The right to copyright, in the name of St. Jude's Discovery Center Preschool, St. Jude of the Lake, Church of St. Pius X, and the Archdiocese of Saint Paul and Minneapolis, works that contain the image of My Child; 6. The right to use and publish for general communications, advertising, commercial or publicity purposes, or for any other lawful purpose whatsoever My Child’s original work; and 7. The right to assign the above-mentioned rights to third parties without notice to me. I understand that the video files, still photos, or other media incorporating the image of My Child will become the property of St. Jude's Discovery Center Preschool, St. Jude of the Lake, and Church of St. Pius X. I hereby waive the right to inspect or approve the image or any finished materials that incorporate the image. I understand and agree that no compensation will be provided, now or in the future, in connection with the use of My Child’s image or My Child’s original work. I hereby release, discharge, and agree to indemnify and hold harmless St. Jude's Discovery Center Preschool, St. Jude of the Lake, Church of St. Pius X, the Archdiocese of Saint Paul and Minneapolis, and their agents, employees and assigns from any and all claims, demands, right, and causes of action of whatever kind that I or My Child have or may have or may arise by reason of this authorization and from the use of My Child’s image and original work, including but not limited to, all claims for libel and invasion of privacy. This consent regarding My Child’s likeness and original work is valid until such time as I choose to rescind this authorization and consent. If I choose to rescind this authorization and consent, I agree that I will inform St. Jude's Discovery Center Preschool in writing and that my rescission will not take effect until it is received by St. Jude's Discovery Center Preschool. I understand and acknowledge that it may not be possible to recall any work or photos that have been published prior to receipt of my written rescission. I hereby authorize and consent that St. Jude's Discovery Center Preschool, St. Jude of the Lake, Church of St. Pius X, and the Archdiocese of Saint Paul and Minneapolis have the right to use My Child’s name in connection with their educational, promotional, fund-raising activities, or for any other legitimate purpose.

I hereby warrant that to the best of my knowledge my child is in good health and I assume all responsibility for the health of my child.

By my signature below, I acknowledge and agree this electronic or digital signature is the legally binding equivalent to my handwritten signature.  This electronic or digital signature has the same validity and meaning as my handwritten signature.  By my signature below as guardian/participant, I acknowledge and agree to the conditions above.