St. Andrew the Apostle FFS &lt;br&gt;Minor Permissions

Event Information

Start Date: REQUIRED Please fill out this field. Please enter a date.
End Date REQUIRED Please fill out this field. Please enter a date.
Place of Event: REQUIRED Please fill out this field. Please enter valid data.

Student/Minor REQUIRED Please fill out this field.
Minor 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Gender REQUIRED Male Female Please fill out this field.
- Student/Minor Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- During the above named activity, my child has my permission to take the following: REQUIRED My child will be taking a prescription medication. My child will be taking a non‐prescription medication. My child will not be bringing any medications, but I authorize, if needed, school/parish/diocesan staff to give my child non‐prescription, over‐the‐counter, medications: Please fill out this field.
- Name of Approved Medications: REQUIRED Please fill out this field. Please enter valid data.
- Notes:/Allergies/Medical Problems/Special Dietary Requirements: Please enter valid data.
Minor 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Gender REQUIRED Male Female Please fill out this field.
- Student/Minor Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- During the above named activity, my child has my permission to take the following: REQUIRED My child will be taking a prescription medication. My child will be taking a non‐prescription medication. My child will not be bringing any medications, but I authorize, if needed, school/parish/diocesan staff to give my child non‐prescription, over‐the‐counter, medications: Please fill out this field.
- Name of Approved Medications: REQUIRED Please fill out this field. Please enter valid data.
- Notes:/Allergies/Medical Problems/Special Dietary Requirements: Please enter valid data.
Minor 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Gender REQUIRED Male Female Please fill out this field.
- Student/Minor Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- During the above named activity, my child has my permission to take the following: REQUIRED My child will be taking a prescription medication. My child will be taking a non‐prescription medication. My child will not be bringing any medications, but I authorize, if needed, school/parish/diocesan staff to give my child non‐prescription, over‐the‐counter, medications: Please fill out this field.
- Name of Approved Medications: REQUIRED Please fill out this field. Please enter valid data.
- Notes:/Allergies/Medical Problems/Special Dietary Requirements: Please enter valid data.
Minor 4
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Gender REQUIRED Male Female Please fill out this field.
- Student/Minor Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- During the above named activity, my child has my permission to take the following: REQUIRED My child will be taking a prescription medication. My child will be taking a non‐prescription medication. My child will not be bringing any medications, but I authorize, if needed, school/parish/diocesan staff to give my child non‐prescription, over‐the‐counter, medications: Please fill out this field.
- Name of Approved Medications: REQUIRED Please fill out this field. Please enter valid data.
- Notes:/Allergies/Medical Problems/Special Dietary Requirements: Please enter valid data.

Parent/Guardian Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Home Address REQUIRED Please fill out this field. Please enter valid data.
City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.

Emergency Contact

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Relation to Minor Please enter valid data.

I, grant permission for my child(ren) listed above, to participate in this school/parish/diocesan event. This activity will take place under the guidance and direction of school/parish/diocesan employees and/or volunteers from St. Andrew the Apostle Catholic Church.

As parent/legal guardian, I remain legally responsible for any personal actions taken by the above named minor participant(s).

I agree on behalf of myself, my child(ren) named herein, or our heirs, successors, and assigns, to hold harmless and defend St. Andrew the Apostle Catholic Church, its officers, directors, employees and agents, and the Diocese of Phoenix, its 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 Diocese of Phoenix, its 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 or the Diocese of Phoenix.

I authorize the making of photographs, motion pictures, video tapes, recordings or other memorializing of said event and my child(ren)’s
participation therein, and the publication and duplication or other use thereof. I waive any rights to compensation or any right that I otherwise might have to limit or control such making or use.

I give permission to the physician, nurse, dentist or licensed care staff selected by the supervisory personnel then present to render medical, dental or other appropriate treatment deemed necessary and appropriate by the physician, nurse, dentist or licensed care staff.

I Agree Please select this field.

Signing Guardian Full Name REQUIRED Please fill out this field. Please enter valid data.

Date REQUIRED Please fill out this field. Please enter a date.

St. Andrew the Apostle FFS
Minor Permissions

Minor Permission & Liability Release

St. Andrew the Apostle FFS Minor Permissions

St. Andrew the Apostle FFS
Minor Permissions