Shine Youth Rally 2019

MSFF SHINE YOUTH RALLY
In His Image Retreat
Diocese of Grand Rapids
OUR LADY OF CONSOLATION PARISH
Parent Permission Form for Retreat Participation

Dear Parent of Legal Guardian:
Your child is eligible to participate in a parish-sponsored activity requiring taking place at OLC Parish. This activity will take place under the guidance and supervision of employees from Our Lady of Consolation Parish. A brief description of the activity follows:

Name of Event: Diocesan Shine Youth Rally
Destination: West Catholic High School, 1801 Bristol Ave. NW, Grand Rapids, MI 49504
Designated Supervisors of Activity:Josh Hanson
Date, Time and Place of Drop Off: West Catholic High School, Saturday March 16, 2019, 1:00 PM
Date, Time and Place of Pick Up: West Catholic High School, Saturday March 16, 2019, 8:00 PM
Method of Transportation: Own
Cost: $35

Statement of Consent

I hereby consent to participation by my child, in the event described above scheduled for Saturday, March 16, 2019. I understand that this event will take place off parish grounds. I further consent to the conditions stated above on participation in this event, including the method of transportation.

In consideration of my child being allowed to participate in this event, I agree to waive and release, and indemnify and hold harmless Our Lady of Consolation Parish, any and all affiliated organizations, its/their employees, agents, representatives, volunteers and drivers, from any and all claims I or my child may have, excluding claims for intentional misconduct or gross negligence, arising from
or relating to my child’s participation in this event.

I authorize Our Lady of Consolation Parish to obtain necessary medical treatment for my child in case of illness, injury, or accident.

List allergies, medication, contacts, or other pertinent comments:
Allergies:

Medication:

Emergency contacts other than yourself:
Name:
Phone:
Comments:

During this event, I can be reached at or

I certify that I am the
of the minor child named above and I agree to the above terms for myself and for my minor child.

Any restrictions or recommendations?

Medical Treatment Release Form

To Whom It May Concern:

As a parent/guardian, I do hereby authorize first aid/medical treatment of my child in the event of an emergency which may endanger his/her life, cause disfigurement, physical impairment, or undue discomfort if delayed. It is understood that efforts will be made to reach me as soon as reasonably possible.

Family Physician:
Phone:
Address:
City:

Health Insurance Data:
Please enter data or none. All spaces must be completed.
Company:
Policy:
Group:
Contract:

This release form is completed and signed of my own free will with the sole purpose of authorizing medical treatment under emergency circumstance in my absence.

PHOTO AND MEDIA CONSENT

As legal guardian of the aforementioned child to participate in the Our Lady of Consolation Parish Formation Programming. I understand that photography and/or video of participants may be procured during Formation Programming and used in promotional materials. I consent to the use of images and likenesses of the aforementioned person, for promotion purposes by Our Lady of Consolation Parish, including the Our Lady of Consolation Parish website and Facebook page.

I accept photos and media as listed above.

Parent and/or Guardian Signature

By selecting the "I Accept" button and typing your name in the space provided, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement.
I Accept

Child Grade

Parent Email: