I, _______________________________ , grant permission for my child,______________________________________,  to participate in this parish activity that may require transportation to a location away from the parish site. This activity will take place under the guidance and direction of parish employees and/or volunteers from Church of St. Michael. 

A brief description of the activity follows:
Type of event: 1K/5K Run, Walk, or Stroll
Location(s): Boeckman Middle School
Individual in charge: Laura Shupe/Sydney Gordon
Duration of activity: August 20, 2022- 8AM-12PM
Mode of transportation to and from event: Parents are responsible for transportation to and from event 

As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor (“participant”). I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend Church of St. Michael, its officers, directors and agents, and the Archdiocese of St. Paul and Minneapolis, coaches, chaperones, or representatives associated with the event, arising from or in connection with my child attending the event or in connection with any illness or injury or cost of medical treatment in connection therewith, and I agree to compensate the parish, its officers, directors and agents, and the Archdiocese of St. Paul and Minneapolis , coaches, chaperones or representatives associated, with the activity for reasonable attorney’s fees and expenses arising in connection therewith.  

BY MY SIGNATURE BELOW, I ACKNOWLEDGE AND AGREE THIS ELECTRONIC OR DIGITAL SIGNATURE IS THE LEGALLY BINDING EQUIVALENT TO MY HANDWRITTEN SIGNATURE. THIS ELECTRONIC OR DIGITAL SIGNATURE HAS THE SAME VALIDITY AND MEANING AS MY HANDWRITTEN SIGNATURE. FURTHER, BY MY SIGNATURE BELOW I ACKNOWLEDGE AND AGREE TO ALL THE TERMS, CONDITIONS ABOVE.  

This form allows you, the parent or guardian, to identify if images of your child and their original works may be used for purposes of print, online, social media communication and promotion.

I am the parent or legal guardian of                                                                           (full name of minor) (“My Child”).

I grant the following rights to Church of St. Michael and the Archdiocese of Saint Paul and Minneapolis:

The right to use all photographs, pictures, portraits, vocal sounds, appearances/likenesses, video and performances (hereinafter collectively known as “image”) of My Child in the possession of Church of St. Michael;

The right to use, reproduce, publish, exhibit, distribute, and transmit the image of My Child individually or in conjunction with other images or printed matter in the production of brochures, slides, motion pictures, broadcasts (radio, television, and other social and digital media), audio or video files, recordings, still photography, CD-ROM and any other manner of media now known or later developed;

The right to use, reproduce, publish, exhibit, distribute, and transmit the image of My Child individually or in conjunction with other images or printed matter on Church of St. Michael and the Archdiocese of Saint Paul and Minneapolis’s Internet websites. No home address or phone number will be published;

The right to record, reproduce, amplify, edit, and simulate My Child’s image and all sound effects produced;

The right to copyright, in the name of Church of St. Michael and the Archdiocese of Saint Paul and Minneapolis, works that contain the image of My Child;

The right to use and publish for general communications, advertising, commercial or publicity purposes, or for any other lawful purpose whatsoever My Child’s original work; and

The right to assign the above-mentioned rights to third parties without notice to me.

I understand that the video files, still photos, or other media incorporating the image of My Child will become the property of Church of St. Michael I hereby waive the right to inspect or approve the image or any finished materials that incorporate the image.

I understand and agree that no compensation will be provided, now or in the future, in connection with the use of My Child’s image or My Child’s original work.

I hereby release, discharge, and agree to indemnify and hold harmless Church of St. Michael the Archdiocese of Saint Paul and Minneapolis, and their agents, employees and assigns from any and all claims, demands, right, and causes of action of whatever kind that I or My Child have or may have or may arise by reason of this authorization and from the use of My Child’s image and original work, including but not limited to, all claims for libel and invasion of privacy.

This consent regarding My Child’s likeness and original work is valid until such time as I choose to rescind this authorization and consent. If I choose to rescind this authorization and consent, I agree that I will inform Church of St. Michael in writing and that my rescission will not take effect until it is received by Church of St. Michael I understand and acknowledge that it may not be possible to recall any work or photos that have been published prior to receipt of my written rescission.

I hereby authorize and consent that Church of St. Michael) and the Archdiocese of Saint Paul and Minneapolis have the right to use My Child’s name in connection with their educational, promotional, fund-raising activities, or for any other legitimate purpose.

I have read the above Disclosures, Authorizations, and Releases, have had the opportunity to consider their terms, and understand them. I execute this document voluntarily and with full knowledge of its significance.

 

BY MY SIGNATURE BELOW, I ACKNOWLEDGE AND AGREE THIS ELECTRONIC OR DIGITAL SIGNATURE IS THE LEGALLY BINDING EQUIVALENT TO MY HANDWRITTEN SIGNATURE. THIS ELECTRONIC OR DIGITAL SIGNATURE HAS THE SAME VALIDITY AND MEANING AS MY HANDWRITTEN SIGNATURE. FURTHER, BY MY SIGNATURE BELOW I ACKNOWLEDGE AND AGREE TO ALL THE TERMS, CONDITIONS ABOVE.  

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. (Of the following statements pertaining to medical matters, sign only those that are applicable.) 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. I wish to be advised prior to any further treatment by the hospital or doctor.

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.

BY MY SIGNATURE BELOW, I ACKNOWLEDGE AND AGREE THIS ELECTRONIC OR DIGITAL SIGNATURE IS THE LEGALLY BINDING EQUIVALENT TO MY HANDWRITTEN SIGNATURE. THIS ELECTRONIC OR DIGITAL SIGNATURE HAS THE SAME VALIDITY AND MEANING AS MY HANDWRITTEN SIGNATURE. FURTHER, BY MY SIGNATURE BELOW I ACKNOWLEDGE AND AGREE TO ALL THE TERMS, CONDITIONS ABOVE.  

 In the event it comes to the attention of the parish, its officers, directors and agents, and the Archdiocese of St. Paul and Minneapolis , coaches, chaperones, or representatives associated with the activity that my child becomes ill with symptoms such as headache, vomiting, sore throat, fever, diarrhea, I want to be called collect (with phone charges reversed to myself)  

BY MY SIGNATURE BELOW, I ACKNOWLEDGE AND AGREE THIS ELECTRONIC OR DIGITAL SIGNATURE IS THE LEGALLY BINDING EQUIVALENT TO MY HANDWRITTEN SIGNATURE. THIS ELECTRONIC OR DIGITAL SIGNATURE HAS THE SAME VALIDITY AND MEANING AS MY HANDWRITTEN SIGNATURE. FURTHER, BY MY SIGNATURE BELOW I ACKNOWLEDGE AND AGREE TO ALL THE TERMS, CONDITIONS ABOVE.  

My child is taking medication at present. My child will bring all such medications necessary, and such medications will be well-labeled. Names of medications and concise directions for seeing that the child takes such medications, including dosage and frequency of dosage, are as follows:

BY MY SIGNATURE BELOW, I ACKNOWLEDGE AND AGREE THIS ELECTRONIC OR DIGITAL SIGNATURE IS THE LEGALLY BINDING EQUIVALENT TO MY HANDWRITTEN SIGNATURE. THIS ELECTRONIC OR DIGITAL SIGNATURE HAS THE SAME VALIDITY AND MEANING AS MY HANDWRITTEN SIGNATURE. FURTHER, BY MY SIGNATURE BELOW I ACKNOWLEDGE AND AGREE TO ALL THE TERMS, CONDITIONS ABOVE.  

No medication of any type, whether prescription or non-prescription, may be administered to my child unless the situation is life-threatening and emergency treatment is required.

BY MY SIGNATURE BELOW, I ACKNOWLEDGE AND AGREE THIS ELECTRONIC OR DIGITAL SIGNATURE IS THE LEGALLY BINDING EQUIVALENT TO MY HANDWRITTEN SIGNATURE. THIS ELECTRONIC OR DIGITAL SIGNATURE HAS THE SAME VALIDITY AND MEANING AS MY HANDWRITTEN SIGNATURE. FURTHER, BY MY SIGNATURE BELOW I ACKNOWLEDGE AND AGREE TO ALL THE TERMS, CONDITIONS ABOVE.  

I hereby grant permission for non-prescription medication (such as non-aspirin products, i.e. acetaminophen or ibuprofen, throat lozenges, cough syrup) to be given to my child, if deemed appropriate.

BY MY SIGNATURE BELOW, I ACKNOWLEDGE AND AGREE THIS ELECTRONIC OR DIGITAL SIGNATURE IS THE LEGALLY BINDING EQUIVALENT TO MY HANDWRITTEN SIGNATURE. THIS ELECTRONIC OR DIGITAL SIGNATURE HAS THE SAME VALIDITY AND MEANING AS MY HANDWRITTEN SIGNATURE. FURTHER, BY MY SIGNATURE BELOW I ACKNOWLEDGE AND AGREE TO ALL THE TERMS, CONDITIONS ABOVE.  

The parish will take reasonable care to see that the following information will be held in confidence. 

1. Click on link. 
2. Select 1K/5K Run, Walk, or Stroll
3. Pay Registration Fee
$25 (13 and over)
$5 (12 and under)