This Consent and Liability waiver is required for and serves both on-site programs and off-site/field trip events/activities for the stated program year. I grant permission for my child to participate in parish events this year that may require transportation to a location away from the parish site. The activities will take place under the guidance and direction of parish employees and/or volunteers. 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, its officers, directors of the parish and agents, and the Archdiocese of Dubuque, chaperones, or representatives associated with the events, arising from or in connection with my child attending the events or in connection with any illness or injury or cost of medical treatment in connection therewith, and I agree to compensate the parish/cluster, its officers, directors and agents, and the Archdiocese of Dubuque, chaperones, or representatives associated with the events for reasonable attorney's fees and expenses which they may incur in any action I/we may bring against them as a result of such injury or damage, unless such claim arises from the negligence of the parish/school or the Archdiocese of Dubuque. Please select Yes or No below to your permission and agreement of the statement above:
I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. In the event of an emergency, I hereby give 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. In the event of an emergency, if you are unable to reach me contact the emergency contacts/locations as listed in this online registration process. Please select Yes or No to your permission and agreement of the above paragraph:
In the event it comes to the attention of the parish, its officers, directors and agents, the Archdiocese of Dubuque, chaperones, or representatives associated with any off-site activity or while at St. Joseph the Worker that my child becomes ill with symptoms such as vomiting, sore throat, fever, diarrhea, I wish to be notified. Please select Yes or No to your permission and agreement of the above paragraph:
I hereby grant permission for non-prescription medication (such as ibuprofen, Tylenol, throat lozenges, etc.) to be given to my child in the event a condition arises after my child is already in attendance at a parish program/activity. Please select Yes or No to your permission and agreement of the above paragraph:
I understand that by responding “Yes” I hereby grant authority to St. Joseph the Worker for the use of any videos, photos, or similar items to used in social media or on a parish web page.
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Contact Linda Frommelt if you have any questions about the registration process.
Phone: 563-588-1433Email: [email protected]