Mission Trip 2019 Adult Information and Release

  • AUTHORIZATION FORM FOR MEDICAL TREATMENT

    I hereby release and indemnify Holy Family Parish, its staff and its volunteers and the Catholic Bishop of Chicago, a corporation sole, from any and all liability arising from claims of any kind or nature whatsoever from my participation in this event.

    In the event that the undersigned or my authorized physician, cannot be reached, and in the judgment of a responsible person accompanying the group, or other appropriate staff member, if there is a necessity for immediate examination and/or treatment of myself, I hereby authorize any of the aforesaid people to obtain medical services as are deemed necessary for me if I am unable.

  • Person to contact in case of emergency (if unable to reach parent):

  • MM slash DD slash YYYY
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