NCYC 2019 Permission Form

  • PERMISSION & AUTHORIZATION FORM FOR MEDICAL TREATMENT

    I/We, the parent(s) of the above child request that Holy Family Teen Faith program allow my/our child to participate in

    The National Catholic Youth Conference – Indianapolis, Indiana November 21-24, 2019

    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 child’s participation in this event.

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

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

  • Date Format: MM slash DD slash YYYY
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