I/We, (hereinafter “Parents” or “Legal Guardian”), request that our son/daughter, a member of St. Joseph Parish, attend the Appalachia Mission Trip from June 17-23, 2018. I/We hereby grant our permission for our son/daughter to attend this event and we freely and knowingly provide this WAIVER, RELEASE OF LIABILITY AND HOLD HARMLESS AGREEMENT in order to accomplish this purpose.

 In consideration of St. Joseph’s Parish and the Roman Catholic Diocese of Paterson’s acceptance of our son/daughter’s registration and attendance at this trip to and from Paintsville, Kentucky, to the fullest extent of the law, the Parents or Legal Guardian shall indemnify, defend and hold harmless the Most Rev. Arthur J. Serratelli, S.T.D., S.S.L., D.D., Bishop of the Roman Catholic Diocese of Paterson and his successors in office and all employees and agents of the Diocese of Paterson and all affiliated parishes, schools, including St. Joseph’s Parish and institutions from and against any and all claims for bodily injury and/or property damage,  losses and expenses, including but not limited to attorney’s fees, rising out of the attendance of our son/daughter at this event. The Parent's or Legal Guardian’s agreement to indemnify specifically includes any and all claims, damages, losses and/or expenses resulting from bodily injury or property damage, sickness, disease or death or injury to or destruction of tangible property caused in whole or in part by the negligence of a party indemnified hereunder. The Parent's or Legal Guardian’s insurance is primary over all other available insurance. 

I/We further agree that any and all disputes regarding our son/daughter’s registration and attendance at the event from June 17-23, 2018, as well as any and all disputes regarding this WAIVER, RELEASE OF LIABILITY AND HOLD HARMLESS AGREEMENT will be resolved by way of submission to binding arbitration through the auspices of the American Arbitration Association.

In signing this release I/We acknowledge and represent that I/We have read the following WAIVER, RELEASE OF LIABILITY AND HOLD HARMLESS AGREEMENT, understand it and sign it voluntarily as my own free act; no oral representations, statements, or inducements apart from the foregoing written agreement have been made; I am at least 18 years of age and fully competent; and I/We execute this release for full, adequate and complete consideration fully intending to be bound by the same.

I/We can be reached at the telephone numbers referred to in St. Joseph Medical Information Form but if emergency medical care or treatment shall be necessary and if I/we cannot be reached, I/We authorize the delegated agents of the Diocese of Paterson to act on my/our behalf and approve appropriate treatment. I/we understand that I/we remain responsible for my/our child’s medical expenses.  I/We have read the foregoing MEDICAL INFORMATION FORM and WAIVER, RELEASE OF LIABILITY AND HOLD HARMLESS AGREEMENT and the answers are all correct.

I (parent or guardian) hereby give permission for my child to attend an event coordinated by Good Neighbors, Inc. I hereby authorize and empower Good Neighbors, Inc. and any adult authorized to act on behalf of Good Neighbors, Inc. to order or approve medical treatment for my child as fully as I could do if I were on site. Good Neighbors, Inc. and its authorized adult representatives are hereby authorized and empowered to utilize their discretion to submit my child to any form or type of medical procedures, by any licensed health care provider. I hereby grant Good Neighbors, Inc. and its authorized adult representatives, a medical power of attorney as to my child and I grant to them the power to make all medical decisions and to authorize and approve all medical decisions and procedures in the same manner as I would if I were personally making such decisions.

I understand and agree that I am responsible for my child’s medical insurance. I agree to reimburse Good Neighbors, Inc. for any medical bills or other expenses incurred regarding any medical treatment for my child.  I have provided Good Neighbors, Inc. with an accurate health history for my child on the Registration Form.

I understand that Good Neighbors, Inc. is not responsible or liable for my child’s personal effects and property, and that Good Neighbors, Inc. will not provide security for or lock up for any items.  I will hold Good Neighbors, Inc. harmless in the event of theft or loss resulting from any source or cause. I further understand that my child is to abide by whatever rules are in effect at the time of the trip.

By my digital signature, for myself, my estate and my heirs, I release, discharge, indemnify, and forever hold harmless Good Neighbors, Inc. and all of its officers, agents, employees, volunteers, member churches, and related persons and entities from any liability, damage, claim, expense, injury, death or other loss of any nature involving or related in any way to myself or my child, even though such liability, loss, damage, claim, expense, injury, or death may have been caused in part or exclusively by any negligence of Good Neighbors, Inc. or negligence of one or more or its officers, agents, employees, volunteers, member churches, or related persons or entities. My indemnity agreement extends to attorney fees and all litigation costs.

**Attending permits your child’s image to be used for print and video promotion by Good Neighbors, Inc.**

The $415 cost per teen covers the fee Good Neighbors charges for each teen to join in their Mission Trips to help with the cost of food and lodging, materials and supplies for their worksites, activities, etc. All teens and parents are needed to help out with the fundraising efforts to cover all other costs such as van rentals, gas, incidentals and work site contributions to assist in the various projects we are assigned. 

How else can you help out? Below is a list of our major fundraisers and opportunities.  All teens should plan on attending EVERY fundraising event.  If parents can help out with an event please check the appropriate box:

If you would like further information on any of the above opportunities, please contact: Monica Micera at (908)963-4546 monicamicera@aol.com or Mark Tosso at (973)543-5950  tosso@stjoesmendham.org

This section enables us to do our best to match your skills to the work.  There’s a chance you may be over-skilled for the work assigned to you. Thanks for being willing to serve wherever we place you. Please check all the numbers in every category that BEST describe you. It's OK if you don't have any experience! We'll teach you.

Your application has been placed on a waitlist as we evaluate space availability. We won't leave you hanging!
You will be notified by early January about your status.  DEFINITELY sign up as applications WILL be taken off of the waitlist on a first come basis.  Feel free to call Monica Micera at 908-963-4546 or MonicaMicera@aol.com for further questions.