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. In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor.

 

In the event it comes to the attention of the parish/school, its officers, directors and agents, and the Archdiocese of Dubuque, chaperones, or representatives associated with the activity that my child becomes ill with symptoms such as vomiting, sore throat, fever, diarrhea, I want to be notified.

 

I hereby grant permission for nonprescription medication (such as ibuprofen, Tylenol, throat lozenges, etc.) to be given to my child in the event a condition arises after my child is already in attendance at the on site program.


 

I understand that by responding "Yes", I hereby grant authority to my child's parish/cluster for the use of any videos, photos, or similar items to use in social media or on a parish/cluster website.


 

Please check one of the following:

Yes = I am the parent/guardian of the particant(s) named above and have the legal authority to execute the above permission(s).  I consent to signing this document electronically as demonstrated by typing my name and checking "Yes" below.

No =  I am unwilling to sign form electronically.  I understand that I must contact the parish office for a hard copy of the liability waiver before my child can participate in the program.