2023 PSR CONSENT AND RELEASE FORM
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Parent's Name *
Email *
Phone number
Child or Children's Name ( You can list more than one child below) *
Liability Waiver: I, the parent and/or legal guardian, grant permission for my child to participate in St. Patrick Catholic Church Faith Formation Programs. I agree to hold harmless St. Patrick Catholic Church, its employees and agents, chaperones or representatives associated for these events from any claims, damages to personal property, or injury which may result during these events. I understand that St. Patrick Catholic Church will not be liable if my child fails to cooperate with the rules and regulations, and that any infraction of the rules may result in my child's dismissal from the Faith Formation program or event. Type your name below.
Medical Release: 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. IF needed for health reasons, I give permission for my child to be evaluated, diagnosed, treated, and/or given medication in accordance with standard medical practice by appropriate health care personnel. In the event of an emergency, I hereby give my permission to transport my child to a hospital for emergency medical or surgical treatment. Type your name below.
In the event of an emergency, if you are unable to reach me at the above number, contact: (include name and number below)
Medical Information: Please list any allergy reactions, physical limitations and/or special medical conditions of your child. Include child's first and last name is listing more than one child.
Photo Release: I hereby grant the right for authorized representatives of St. Patrick Catholic Church to take, edit, copy, publish, distribute and make use of any and all pictures or videos taken of my minor child to be used in and/or for advertisements, submissions to journalists, websites, social networking sites, and other print and digital communications, without payment or any other consideration. This authorization shall continue indefinitely, unless I otherwise revoke said authorization in writing.  Type your name below.
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