MEDICAL RELEASE AND WAIVER

I/We understand that the Saint Anthony Religious Education Programs assume no responsibility for accidents which may occur in association with related events and activities. I/We agree to use my/our personal insurance to cover any such incidents.

I/We understand that, in the event medical intervention is needed, every attempt will be made to contact the persons listed above. In the event those individuals cannot be reached, I/We hereby give permission to the Program staff to make emergency decisions as deemed necessary.

I understand all reasonable safety precautions will be taken at all times by the Religious Education and its staffs during the events and activities. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree to indemnify and hold harmless Saint Anthony Parish, its Religious Education Program, its leaders, staffs and volunteer staff from any claim arising from or in connection with attending this program.

I agree to abide by and/or instruct Participant to abide by all rules and regulations as outlined by the aforementioned representatives. I agree that if I/Participant fail(s) to abide in any way by the rules, that I/Participant can be dismissed from the program.

Photo Release:

I hereby authorize the Saint Anthony Religious Education Program, and its staffs to utilize photographic and/or video images of me or my child. In giving my consent, I hereby indemnify and hold harmless Saint Anthony Religious Education Program and its staffs from any and all responsibility or liability. I understand that I will receive no compensation, should any photograph and/or video of me or my child be used.

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Participant Full Name *
Date of Birth *
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GENDER *
Home Address *
Participant's Phone Number
Parent's Email Address
Current Parish
Primary Doctor of Participant *
Doctor's Phone Number *
Insurance ID# *
Insurance Group ID# *
Insurance Card Holder's Name *
Any Allergies?

I HAVE READ THIS WAIVER AND FULLY UNDERSTAND ITS TERMS. I UNDERSTAND IT IS A PROMISE NOT TO SUE AND A RELEASE AND INDEMNITY FOR ALL CLAIMS, AND THAT I AM GIVING UP SUBSTANTIAL RIGHTS, INCLUDING MY RIGHT TO SUE. I ACKNOWLEDGE THAT I AM SIGNING THIS WAIVER FREELY AND VOLUNTARILY, AND I INTEND MY ACCEPTANCE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.

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