St. Francis Xavier PSR/Edge Consent 2023-2024

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Below please complete the forms giving permission for your child to participate in our PSR/Edge activities for the time period August 1, 2023, to July 31, 2024.

Email *

First Name *

Last Name *

Date of Birth *

YYYY

Emergency Cell number *

Mother's name *

Mother's cell *

Father's name *

Father's cell *

I give my permission for the above named Individual to attend the activities listed above and agree to all terms and conditions stated above. *

Yes

Required

By typing my name below, which shall constitute my electronic signature, I acknowledge that I am the legally duly authorized parent, legal guardian, or caregiver of the Individual(s) named in this form and have the authority to sign this document and act on his/her or their behalf. I agree that my electronic signature is intended to authenticate this writing and to have the same force and effect as my manual signature. My signature below indicates that I have read, understood, and freely signed this agreement. I further certify that I am at least eighteen years of age and that I am otherwise legally competent to sign this agreement. I further understand that the terms of this agreement are legally binding. This agreement shall be construed and enforced in accordance with the laws of the State of Ohio, and I consent to the jurisdiction of said state. If any portion of this agreement is held invalid, it is agreed that the balance shall continue in full legal force and effect. *

Today's date *

YYYY

If your child is NEW to SFX or in first grade, please upload or scan your child's baptismal record. We will need this prior to the first day of PSR. Please send this to dmcewen@sfxmedina.org *

I scanned/uploaded to dmcewen@sfxmedina.org because my child is new to the PSR program.

My child is NOT a new student to the PSR program, therefore their records are on file.

Required

Clear form

Never submit passwords through Google Forms.

This form was created inside of St. Francis Xavier. Report Abuse

Forms