St. Mary's Open Gym Permission Form

Required registration for Open Gym this year.

 

If you have any questions, please contact Jennifer Morrison at familyfaith.smpm@gmail.com.


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E-Mail-Adresse *
Family Last Name *
Parents First Name(s) *
Street Address *
City *
Zip Code *
Home/Primary Phone Number: *
Cell/Secondary Phone Number: *
Youth Full Name *
Youth Grade Level *
Pflichtfrage
Sex *
Family Physician
 *
Physician Phone *
Physician Address *
Emergency Medical Treatment/Emergency Contact*
I authorize St. Mary's staff or representative to provide emergency medical treatment of any injury to or illness by my child if qualified medical personnel consider treatment necessary. I further authorize any qualified, licensed physician to render medical treatment which in his or her judgment may be deemed necessary in the care of my child.
In the event of an emergency, if you are unable to reach me at the above numbers.   
Please enter Emergency Contact Name:
 *
Please enter Emergency Contact Phone Number
 *

Consent to Participate

I consent to the participation of my CHILD/WARD in the above named ACTIVITY. In consideration for my CHILD/WARD’s participation, I agree to reimburse and indemnify the PARISH (understood to include The Archdiocese of Boise) for all reasonable legal and court fees incurred by PARISH in defending a lawsuit that I or my CHILD/WARD may bring against the PARISH which relates to the above named ACTIVITY if the PARISH is found not legally liable by the courts and prevails in the lawsuit. If the PARISH is found legally liable for injuries sustained by CHILD/WARD, this paragraph will not apply.

 I certify that I have an understanding of this agreement and any risks and hazards associated with the ACTIVITY described above that my CHILD/WARD will be participating in. I further understand that I had the opportunity to fully discuss this agreement with a representative of the PARISH to clarify any concerns or questions about the ACTIVITY or this agreement that I may have had.

 Please check below to electronically sign this form.

My electronic signature on this form indicates my intent to adopt the content of this form and communicate such information and consent electronically to St. Mary's Parish. *
Pflichtfrage

Photo/Video Consent*

By checking the box below you consent to the use by St. Mary's Parish any videotape, photograph, slide, audiotape, or any other visual or audio reproduction in which I or my child(ren) may appear. I understand that these materials may be used in programs or used for promoting family catechesis. Such promotional activities extend to educational materials, recruitments, fund-raising, advocacy, etc. I release the staff, volunteers, etc. of St. Mary's Parish or the Archdiocese of Boise represented from any liability connected with the use of my or my child's picture or voice recording as part of any of the above or similar activities.

Risk Acknowledgement*

I/We will realize that there are numerous risks involved in participating in the above listed sport(s). These risks could involve (but are not limited to): sprains, contusions, broken bones, lacerations, concussions, permanent disability, internal injuries, paralysis, and possibly death. These risks could impair my/our child’s future abilities to earn a living, engage in business, social, and recreational activities and to generally enjoy life. I/We have been informed about the various risks associated our child’s participation in the above listed sports and the potential injuries that may occur.

 I/We will assume all responsibility and certify my/our child is in good physical condition and has undergone a sports physical in the past two years. Further, I/we are unaware of any medical condition that would inhibit my/our child’s participation.

 As a condition of our child’s voluntary participation in the above mentioned sports, I/we agree to accept all the previously mentioned risks as a condition of my/our child’s participation.

 *
Pflichtfrage
Parent/Guardian Signature*

By entering my full name, I attest that this constitutes my legal electronic signature on this form.

 *
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