2020 VBS PARENT GUARDIAN CONSENT FORM IMPORTANT THIS

2020 VBS PARENT /GUARDIAN CONSENT FORM IMPORTANT! THIS PAGE MUST BE SUBMITTED WITH REGISTRATION FORMS! To be filled out by the parent or legal guardian of children under the age of 18. Print the names & grades (as of 9/1/2020) of all the children or youth from the attached registration form(s). 1 ___________________________________________________ Name Grade 4 2 ___________________________________________________ Name Grade 5 Grade Name MEDICAL CONSENT 3 ________________________ 6 In the event of an emergency, I hereby give permission to the staff of St. . Paul & St. Mary of the __________________________ Expectation Catholic or treatment for my child named Name Church to seek emergency medical transport. Grade Nameabove. I will be responsible for costs incurred. I wish to be advised Grade before further care is given by the hospital or doctor. If I cannot be reached, contact: Name & Relationship ____________________ Phone (______)_________ Family Doctor _________________________ Phone (______)__________ Insurance Name ___________________ Group Number _______________ Insurance Phone Number (____)___________ here if not insured □ Check On the back, list any medical conditions, life-threatening allergies, etc. for 1 -6 above. In the event of any accident or injury, I agree on behalf of myself, my child’s other parent if known or living VIDEO /PHOTOGRAPH CONSENT (name of other parent) __________________, the children named above, or our heirs, successors, and assigns, to holdthat harmless and defend of Galveston-Houston, its pastor As parent /guardian, I understand promotional picturesthe and. Archdiocese videos (individual and group) may be taken duringor any representative of Faith Formation and Youth Ministry, unless the parties involved were negligent. VBS activities. I give permission for my child’s pictures (named above) to be used for church promotional materials such as newsletters, web pages, calendars, Power Point presentations, or videos to promote or highlight these Signature Date ___________ activities. of My. Parent child’s/Guardian name will _____________________ not be released without further consent. Signature of Parent /Guardian _____________________ Date ___________ CONSENT & LIABILITY WAIVER I AM THE PARENT OR LEGAL GUARDIAN OF THE CHILD /YOUTH NAMED ABOVE. I HAVE READ THE PARENT /GUARDIAN REGISTRATION AND CONSENT FORMS. I FULLY UNDERSTAND ACCEPT THESE POLICIES AND GUIDELINES KNOWINGLY, FREELY AND WILLINGLY. Parent’s Printed Name ______________________________________ Signature of Parent /Guardian ____________________ Date ____________

List any medical conditions, life-threatening allergies, accommodations needed for participation etc. for each child or youth #1 -6 named on the reverse side. Please enter information on the corresponding numbered line. This information will remain confidential and shared only as necessary. 1 ______________________________________________________ 2 ______________________________________________________ 3 ______________________________________________________ 4 ______________________________________________________ 5 ______________________________________________________ 6 ______________________________________________________