St. Joseph the Worker &
Holy Family Parish Cluster

Parent Permission For Youth Event

- Faith Formation

"The Eucharist...calls us to right relationship with God, ourselves, and others, invites us to community and solidarity, and SENDS US ON MISSION to help transform our communities, neighborhoods, and world." USCCB
Click image for more details on event!
The maximum number of form submissions has been reached. This form is currently not available.
- Parish Parental Consent for: Oct 7: LIFELINE & Feed My Starving Children Mar 2: LIFELINE & Feed My Starving Children
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Parent/Guardian Phone Number #1 REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Parent/Guardian Phone Number #2 REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Child's Date of Birth REQUIRED Please fill out this field. Please enter a date.
- School Grade at Time of Event REQUIRED Please fill out this field. Please enter a date.
- PARISH PARENTAL CONSENT/LIABILITY WAIVER/MEDICAL RELEASE: I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend the above named parish/school, it's officers, directors, employees and agents, and the parishes of St. Joseph the Worker and Holy Family, it's employees and agents, chaperones, or representatives associated with the event, from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the parish/school, its officers, directors and agents, and the parishes of St. Joseph the Worker and Holy Family, it's employees and agents and chaperones, or representative associated with the event for reasonable attorney's fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the parish/school.
  I Agree Please select this field.
- IMAGE WAIVER: I understand and agree that any photograph, video, and internet site image of my child during this event may be used for promotional purposes.
  I Agree Please select this field.
- EMERGENCY MEDICAL TREATMENT: In the event of an emergency, I give permission to transport my child to a hospital for medical treatment. I wish to be advised prior to any further treatment by a doctor or hospital.
  I Agree Please select this field.
- Medications My Child Is Taking
- My child will bring all such medications necessary, and such medications will be well-labeled and in original containers. Names of medications and concise directions for seeing that the child takes such medications, including dosage and frequency of dosage is as follows:
- Directions for Medications
- Family Health Plan Carrier, Policy #, Family Doctor, Clinic, and Phone Number REQUIRED Please fill out this field. Please enter valid data.
- The undersigned parent/guardian hereby consents that the parishes of St. Joseph the Worker and Holy Family are permitted to use and publish for advertising commercial or publicity purposes, the photograph or video of my child for lawful purpose and the undersigned parent guardian does hereby release the parishes of St. Joseph the Worker and Holy Family from any liability in connection with such use.
  
  *As a parent/guardian, I agree to all of the above stated considerations and conditions.
- Parent/Guardian Signature Please enter valid data.
Submit

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.