I grant permission for my child to participate in this parish/school event that requires transportation to a location away from the parish/school site. This activity will take place under the guidance and direction of parish/school employees and/or volunteers from Divine Mercy Catholic School.

I understand and agree that as parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor (“student/participant”). Further, 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.

I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and 

defend Divine Mercy Catholic School, its officers, directors, employees and agents, and the Archdiocese of Saint Paul and Minneapolis, its employees and agents, chaperones, or representatives associated with the event and activities (hereinafter “Releases”), from any claim, including but not limited to all claims relating to communicable disease, arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate Releases for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of Releases.

Emergency Medical Treatment: In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. In the event of an emergency, if you are unable to reach me at the above numbers, contact: 

Specific Medical Information: The parish/school will take reasonable care to see that the following information will be held in confidence.

Medications: My child is taking medication at present. My child will bring all such medications necessary and such medications will be well-labeled. Please indicate "None" if this does not apply.

Allergic reactions (medications, foods, plants, insects, etc.). Please indicate "None" if this does not apply.:

Special medical conditions of my child. Please indicate "None" if this does not apply.:

DISCLOSURE STATEMENT: As Parent or Guardian, please indicate whether you AGREE or DO NOT AGREE to all of the above stated considerations and conditions.