I, _______________________, hereby acknowledge that on ________________________, 20__, I/my child am/is scheduled to take a trip to _______________________________ arranged by and through ______________________________. In consideration for the arrangement of this trip by  ____________________________, I make the following acknowledgments, agreements, and promises:

I expressly acknowledge that there are many risks inherent in traveling to a foreign country. I expressly agree to assume these risks and hereby release and hold harmless the Archdiocese of Miami and ___________________________ from any and all liability, loss, injury, or claim I may have as a result of this scheduled trip to ________________________, whether or not said claim or injury results from the negligence of the Archdiocese of Miami, __________________________, or any of their agents.

I hereby release and hold harmless the Archdiocese of Miami and ___________________________ from any loss I may incur from any illness, disease, injury or loss I may suffer on this trip or related to my taking this trip, whether or not said claim or injury results from the negligence of the Archdiocese of Miami, _____________________________ or any of their agents.

I hereby release and hold harmless the Archdiocese of Miami and ___________________________ from any acts of God, fire, enemies, terrorism, pirates or assailing thieves which may cause death, injury, delay, or loss during this trip, whether or not said claim or injury results from the negligence of the Archdiocese of Miami, ___________________________ or any of their agents.

I hereby release and hold harmless the Archdiocese of Miami and ___________________________ from any and all claims any person may have through me in a court of law, including, but not limited to, a surviving spouse or other legal representative, whether or not said claim or injury results from the negligence of the Archdiocese of Miami, ______________________ or any of their agents.

CHECK ONE:

_____ I am of legal age and have the right to contract in my own name. I have read the foregoing and fully understand the contents thereof. This release shall be binding upon me and my heirs, legal representatives and assigns.

_____ I am the parent or legal guardian of ______________________, and in that capacity I hereby agree to the above acknowledgments, agreements and promises on his/her behalf.

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Print Name

____________________________

Produced as Identification

____________________________

Signature

STATE OF _________________ ) ) ss COUNTY OF _______________ )

The foregoing instrument was acknowledged before me this ______ day of ______________, 20____, by _______________________, [ ] who is personally known to me or [ ] has produced ___________________ as identification.

____________________________ NOTARY PUBLIC, State of Florida at Large

My Commission Expires: