Totus Tuus Camper Registration

Row ID Camper Name Actions

Emergency Parent Contact Information

Parent Name(Required)
Media Release Acknowledgment(Required)
I have read and consent to the following release and I fully understand the contents, meaning, and impact of this release
Media Release I hereby grant the Diocese of Springfield in Illinois permission to use my likeness in a photograph, or any filmed, video, or taped media, in any and all of its publications, including website entries, without payment or any other consideration. I understand and agree that these materials will become the property of the Diocese of Springfield in Illinois and will not be returned. I hereby irrevocably authorize the Diocese of Springfield in Illinois to edit, alter, copy, exhibit, publish or distribute this photo or any filmed, video, or taped media for purposes of publicizing the Diocese of Springfield in Illinois’ programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph or other media. I hereby hold harmless and release and forever discharge the Diocese of Springfield in Illinois from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I am 18 year of age and am competent to contract in my own name.
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