As the parent or legal guardian, I hereby authorize first aide/medical treatment (for all children listed on this form) in the event of an emergency, which may endanger her/his life, cause disfigurement, physical impairment, or undue discomfort if delayed. It is understood that efforts will be made to contact the person listed on this form as soon as reasonably possible. In the event that the aforementioned requires my authorization for treatment and I cannot be reached in an emergency, I hereby give my permission to the physician selected by the activity leader to hospitalize, secure medical treatment, and/or order an injection, anesthesia or surgery for the aforementioned as deemed necessary.
I understand all reasonable safety precautions will be taken at all times by the parish and its agents during youth programming and events. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold St. Sebastian Church, its leaders, employees, drivers, volunteers, or the Roman Catholic Diocese of Grand Rapids liable for damages, losses, diseases, or injuries incurred by the aforementioned.
By checking the box you are agreeing to the above Medical Treatment Release Statement for all children listed on this form.
