Please read the form thoroughly.
GENERAL
HEALTH HISTORY
PHOTO AND VIDEO RELEASE
From time to time, pictures and video may be taken of youth ministry events and gatherings. We would like to be able to use these photographs and videos for flyers, parish and diocesan publications, and the ministry website. Written consent of both the student and parent/guardian is required. Names will not be posted unless written authorization is given by the student and parent/guardian, and then only first names will be used. If there are concerns about pictures or videos posted on the website, please contact the ministry coordinator or webmaster, and they will promptly be removed.
ministry. There will be no compensation for use of any photograph or video at the time of publication or in the near future.
INSURANCE INFORMATION
** Please understand that depending opon the serious of the situation, your child may be transported to the nearest hospital.
or his/her respresentative to hospitalize and/or secure proper medical treatment for my above named child.
By checking this box, I acknowledge and understand that I am responsible for the cost of any medical treatments (including surgery) received by my child. I hereby release the directors and staff of this event from all responsibility for sickness or accidents which occur during the event. I understand that I will be contacted immediately in the case of an emergency.
Form updated 12/18/25
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