For all participating in the pilgrimage to the Salton Sea a registration form must be filled out and submitted.

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* 1. Name of Activity Participant (Pilgrim)

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* 2. Phone Number

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* 4. Emergency Contact

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* 5. Emergency Contact Phone Number

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* 6. Home Address

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* 7. Parish

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* 8. Parish is understood to include the Arch/Diocese of

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* 9. Name of Secondary Activity Participant (if filling out for a minor)

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* 10. DATES OF ACTIVITY OR USAGE:

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* 11. TYPE OF ACTIVITY OR USAGE:

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* 12. Are there any allergies, medications, or conditions you would like us to know about in case medical help is required during the pilgrimage?

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* 13. Questions, comments, or concerns? Share with us here.

The above named ACTIVITY PARTICIPANT OR FACILITY USER agrees to defend, protect, indemnify and hold harmless the above named PARISH against and from all claims arising from the negligence or fault of the above named ACTIVITY PARTICIPANT OR FACILITY USER which arise out of the above named ACTIVITY OR USAGE at the above named PARISH including but not limited to any personal injury, property damage, disability, death, and sickness or disease including, without limitation, any communicable disease.

Additionally, the above named ACTIVITY PARTICIPANT OR FACILITY USER agrees to protect, defend, hold harmless and fully indemnify the above named PARISH for any claim or cause of action whatsoever arising out of the above mentioned ACTIVITY OR USAGE which takes place during the above identified DATE(S) OF ACTIVITY OR USAGE that is brought against the PARISH by the above named ACTIVITY PARTICIPANT OR FACILITY USER or their family members whether such claim arises from the alleged negligence of the PARISH, its employees or agents or ACTIVITY PARTICIPANT or FACILITY USER’S negligence. If any portion of this agreement is held invalid, it is agreed that the balance thereof, shall continue in full legal force and effect.

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* 14. Signature (type)

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* 15. DATE

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