ANNUAL - YOUTH AUTHORIZATION 2023-2024 R 22 Diocese of Fresno (DOF) and all Entities of the Diocese of Fresno: Permission for a Minor to Participate in DOF Activities, Release of Liability, and Consent for Emergency Medical Treatment
I, the undersigned parent or legal guardian, voluntarily wish to give permission for and request that my child be allowed to attend and participate in children's choir and/or religious education during this calendar year. I have informed my child to cooperate and conform with the rules, guidelines, and instructions given by DOF personnel or agents, or chaperones, or responsible for DOF events and activities.
In exchange for permitting my child to participate in children's choir and/or religious education, I waive and give up all claims (and the right to file a lawsuit) which I or my child (and our successors, heirs, and assigns) may have against DOF. I release and discharge the DOF from all liability or responsibility for death, illness, personal injury, or property damage arising out of DOF activity.
In the event of an emergency and if the DOF is unable to contact me, I authorize the DOF personnel or other adult leadership of St. Ann, at my expense, to secure and consent to x-ray examination, medical, dental, or surgical diagnosis, treatment, and hospital care advised and supervised by a duly licensed physician, surgeon, or dentist. I expect to be contacted as soon as possible. I agree that if emergency medical or dental services are required for my child, the DOF will not be responsible to pay for any medical or dental expenses.
This permission, waiver, release, and consent applies to the DOF named, including but not limited to the Diocese of Fresno Education Corporation; the Roman Catholic Bishop of Fresno (a corporate sole); the Diocese of Fresno; other Fresno Diocesan Parishes and Schools; affiliated organizations and officers; clergy; agents; and employees.
This waiver and release form is signed in order for my child to participate in children's choir and/or religious education for my child's own personal enjoyment and benefit and is done so freely with the knowledge of the risk and dangers that are or may be involved.
I authorize any hospital which has provided treatment to the named participant pursuant to the provision of Family code section 6910 to surrender physical custody of such minor to the DOF representative upon the completion of treatment. This authorization is given pursuant to Health and Safety code section 1283.
I, the undersigned, have read this release and understand all of its terms. I request that my child be allowed to participate in children's choir and/or religious education. I execute this form voluntarily and with full knowledge of its significance. I have discussed the above with my child, and my child is aware of and understands the importance of following all rules set out for children's choir and religious education. A copy or digital image of this form shall be as valid as the original authorization. PARENT OR GUARDIAN TYPE FULL NAME BELOW