Serving the Lakeside Communities of Avon Lake and Bay Village

Volunteer for Vacation Bible School

A Wild Time with Jesus

July 23, 24 and 25 - 9:15 a.m. to Noon

Photo Release

I understand that photos may be taken of my student during faith formation classes and events. I hereby give Holy Spirit Parish permission to publish photographs taken of my student, for use in Holy Spirit Parish publications and on the Holy Spirit website. I release Holy Spirit Parish from any expectation of confidentiality for my student and attest that I am the parent or legal guardian of the student I am registering and that I have the authority to authorize Holy Spirit to use their photographs and names.

Emergency Medical Authorization/Refusal

Purpose: To enable parent(s)/guardian(s) to authorize emergency treatment for a student who becomes ill/injured while under parish school of religion authority. This is an important precautionary measure in case the parent(s)/guardian(s) cannot be reached, but, it is hoped, it will never need to be used.

Complete PART I to grant consent. Complete PART II to refuse consent.

PART I: In the event reasonable attempts to contact me or my alternate have been unsuccessful, I hereby give my consent
1. for the administration of any treatment deemed necessary by my
preferred doctor/dentist or by another licensed physician/dentist if my
designated preferred practitioner is not available
and
2. for the transfer of the student to my preferred hospital or any reasonably
accessible hospital.

This authorization does not cover any major surgery unless the medical opinions of two other licensed physicians or dentists concur in the necessity for such surgery, and concurrence is obtained before the surgery is performed.



 
 

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