9408 Wilson Ave SW, Byron Center, Mi 49315

(616) 878-1619

Email: parishoffice@stsebastianmi.org

2022-2023 Religious Education and Youth Ministry Family Medical Release Form

2022-2023 Medical Release Form

Please fill out and list each child you are enrolling in our Religious Education and Youth Ministry program for the 2022-2023 school year.
  • Medical Treatment Release

    As the parent or legal guardian, BY CLICKING “SUBMIT” BELOW I hereby authorize first aide/medical treatment for my youth(s) who is/are listed above 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 emergency contact person listed on this form as soon as reasonably possible. In the event that my youth(s) 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 my youth(s) as deemed necessary. Furthermore, BY CLICKING “SUBMIT” BELOW I understand all reasonable safety precautions will be taken at all times by the parish and its agents during youth programing and events. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree to waive and release, and indemnify and hold harmless Saint Sebastian Church, any and all affiliated organizations, its/their employees, agents, representatives, volunteers and drivers, from any and all claims my child may have, excluding claims for intentional misconduct or gross negligence, arising from or relating to my child’s participation in this event.
  • Custodial Acknowledgement/Alternative Pick-up

    Please list ALL individuals who are authorized to pick-up your child(ren) from Religious Education and/or Youth Ministry program events:
  • By clicking "SUBMIT" below, I designate these individuals authority to pick up my child(ren) from Religious Education and/or Youth MInistry program events. In the event that someone NOT included on this list is going to pick up my child(ren), I will notify, in writing, the Directory of Religious Education and/or the Youth Minister.
  • Social Media Permission (Grades 7-12 only)

    Parent/Guardian Acceptance of Internet Safety Responsibility During Unplanned Closures and Permission to Deliver Online Content to Youth During unplanned closures, Saint Sebastian Youth Ministry, (SPARKS & IGNITE), makes the effort to provide ministry for young people and families, through various methods including online. This form allows parents/guardians to grant permission for Saint Sebastian Youth Minister and other designated adults to deliver online content and interact virtually with their youth (grades 7-12), with parents copied, and for parents/guardians to accept the parish's responsibilities under the Youth’s Internet Protection Act. Catholic parishes in the Diocese of Grand Rapids follow responsibilities outlined in the Diocesan Social Media Policy, which including responsibilities outlined in the Youth's Internet Protection Act (CIPA). These responsibilities include preventing minors from accessing obscene or harmful content when using parish devices or internet connections on parish property. The protection measures block or filter internet access to pictures that are: (a) obscene; (b) pornographic; or (c) harmful to minors. Additionally, our internet safety policies provide for educating minors about appropriate online behavior, including interacting with other individuals on social networking websites and in chat rooms, and cyberbullying awareness and response. By completing and submitting this form, parents/guardians permit our Youth Minister and other designated volunteers to deliver instructional content directly to their youth (grades 7-12) and for their youth (grades 7-12) to participate in online communications. Parents/guardians will be notified of online activities. Parents/guardians acknowledge their acceptance of the responsibility of their youth’s internet safety and commit to the following: 1) Having a trusted adult monitoring youth who use the internet to access content and online interactions; 2) Using tools such as parental controls and other filters to protect youth's internet access, as described above. (Parental controls can be found under privacy settings of most devices, browsers and applications. Internet service providers also have information about parental control and filters.)