Our Mission: "Go, and make disciples of all people, and proclaim the Gospel to everyone!"
(Of the following statements pertaining to medical matters, sign only those that are applicable).
Emergency Medical Treatment: In the event of an emergency, I hereby grant permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor.
Other Medical Treatment: In the event it comes to the attention of the parish, its officers, directors and agents, chaperons, or representatives associated with the activity, that my child becomes ill with symptoms such as headache, vomiting, sore throat, fever, diarrhea I will be contated immediately.
Medication: My child is taking medication at present. My child will bring all such medications necessary, and such medications will be well-labeled. The names of medications and concise directions for seeing that the child takes such medications, including the dosage and frequency of said dosage, are as follows:
Please be aware, that your child’s picture, video or audio may be taken as part of St. Joseph, Colbert Youth Ministry activities. Such activities include recruitment, fund-raising, etc. (Names will not be used in pictures without specific permission.)
As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor (“participant”). I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend , St. Joseph, Colbert its officers, directors, employees and agents, and the Arch/Diocese of , its employees and agents, chaperons, 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, its officers, directors and agents, and the Diocese of Spokane, its employees and agents and chaperons, 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/diocese.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.