Cathedral and Cossetta's Feb 10, 2023 Permission Form

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Cathedral and Cossetta's Feb 10, 2023 Permission Form

: Cathedral Tour & Dinner at Cossetta's Feb. 10, 2023 Permission Form
: Type of Event: Cathedral Tour, Confession and Dinner at Cossetta's Feb. 10, 2023 Permission Form
Date/Time of Event: Fri. Feb. 10, 2023 meet at St. Pius V at 1:15pm and bus to the Cathedral of St. Paul in St. Paul and then to Cossetta's Restaurant in St. Paul then bus back to St. Pius V parking lot.
Destination: Cathedral of St. Paul in St. Paul and then to Cossetta's Restaurant in St. Paul then bus back to St. Pius V parking lot.
Individual(s)/Teacher(s) in Charge: Cindy Meyers, Kati Moline and Catechists
Mode of Transportation To and From Event: bus
BY CHECKING THE BOX - I GIVE MY CHILD/CHILDREN PERMISSION and By filling out this form, I am agreeing to all the permissions. 1) PARENTS: I GIVE MY PERMISSION FOR MY CHILD/REN to participate in the Church of St. Pius V Faith Formation and Youth Ministry classes/activities. In consideration of my Child’s/ren’s participation, I agree to indemnify the Church of St. Pius V and the Archdiocese of St. Paul/Minneapolis from any claims or law suits brought against the parish/school/ Archdiocese of St. Paul/Minneapolis by myself, my child/ren or others, that arises out of any behavior by my child/ren at the Faith Formation and Youth Ministry classes/activities. I also agree to pay reasonable attorney’s fees or expenses incurred by the Church of St. Pius V and Archdiocese in defense of such a claim/law suit. 2) CONSENT AND PERMISSION TO TREAT MINOR In the event of an emergency, I give permission to transport my child/ren to a hospital for emergency medical treatment. I wish to be advised prior to any further treatment by a doctor or hospital. 3) PHOTOGRAPH/PRESS RELEASE I realize that photographs, videos, written extractions, and voice recordings of program participants the purpose of may be taken during various activities for illustrations, publications, live stream on YouTube, social media platforms, and St. Pius V website/Archdiocese website. No home address or phone number will be published;. By signing this form, I hereby authorize and give full consent to Church of St. Pius V to publish and copyright all photographs, videos, written extractions, and voice recordings in which my child appears while participating in any Faith Formation/Youth Ministry activities. IN CASE OF INJURY OR ILLNESS YOUR OWN MEDICAL INSURANCE WOULD BE USED. MEDICAL INSURANCE PROVIDED BY THE PARISH OR THE ARCHDIOCESE IS LIMITED & IN EXCESS TO ANY OTHER VALID and COLLECTIBLE INSURANCE. Further, 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. I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and
defend St. Pius V, its officers, directors, employees and agents, and the Archdiocese of Saint Paul and Minneapolis, its employees and agents, chaperones, or representatives associated with the event and activities (hereinafter “Releasees”), from any claim, including but not limited to all claims relating to communicable disease, 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 Releases 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 Releases.
I/we the undersigned, have read all releases and understand all its terms and execute it voluntarily and with full knowledge of its significance. I/we the undersigned, have read all releases and understand all its terms and execute it voluntarily and with full knowledge of its significance. Print name.
PERMISSION TO ATTEND: I CONSENT
NAME OF CHILD/CHILDREN I GIVE PERMISSION TO ATTEND
Emergency Medical Treatment: In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. In the event of an emergency, if you are unable to reach me at the above numbers, contact name below as well as any medications. Specific Medical Information: The parish/school will take reasonable care to see that the following information will be held in confidence. Medications: My child is taking medication at present. My child will bring all such medications necessary and such medications will be well-labeled. Names of medications and concise directions for seeing that the child takes such medications, including dosage and frequency of dosage.
EMERGENCY CONTACTS NAME AND PHONE NUMBER
AUTHORIZATION, CONSENT AND RELEASE FOR SOCIAL MEDIA OR OTHER ELECTRONIC COMMUNICATIONS INVOLVING A MINOR I authorize and consent that St. Pius V, Cannon Falls and the Archdiocese of Saint Paul and Minneapolis be permitted to use and publish for general communications, advertising, commercial or publicity purposes, the likeness of My Child and My Child’s original work or for any other lawful purpose whatsoever, including video, photographic portraits, pictures, reproductions, made through any medium, including social or other electronic media, in accordance with the Acceptable Use Policy for Electronic Communications and the Social Media Policy, provided only the first name (not the family name) is identified if any name is used. I hereby release St. Pius V, Cannon Falls, the Archdiocese of Saint Paul and Minneapolis, or anyone authorized by St. Pius V, Cannon Falls or Archdiocese of Saint Paul and Minneapolis with such use. This consent regarding My Child’s likeness or original work is valid for one year. If I choose to rescind my authorization and consent, I agree that I will inform St. Pius V, Cannon Falls in writing and that my rescission will not take effect until it is received by St. Pius V, Cannon Falls. I understand however that it may not be possible to recall any work or photos that have been published prior to receipt of my written rescission. I acknowledge that to review or receive public communications shared via social media with My Child, I would need to become a fan or follower of the same social media. I understand that communications may be accessible or viewable by others who are also fans or followers of the same social media. I have read this disclosure, authorization, consent and release, have had the opportunity to consider its terms, and understand it. I execute it voluntarily and with knowledge of its significance.: I agree.
I WILL REVIEW THE YOUTH CODE OF CONDUCT WITH MY CHILD/CHILDREN: • Treat all other persons with respect and not cause any intentional harm (physically, emotionally, or spiritually) to any person in any way. • Respect the property of others, including all program facilities and property. • Follow all appropriate instructions of all personnel aiding in this event, including, but not limited to chaperones, support staff, transportation personnel and administration. • Be on time for all check-ins and departure time. • Not have in my possession any tobacco, alcohol or any controlled illegal substance.: YOUTH CODE OF CONDUCT REVIEW
BY PRINTING/ADDING MY NAME, THIS SERVES AS AN ELECTRONIC SIGNATURE FOR THE ABOVE PERMISSIONS AND AUTHORIZATION FORM. As Parent or Guardian, I agree to all of the above stated considerations and conditions.
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Cathedral and Cossetta's Feb 10, 2023 Permission Form

Cathedral Tour & Dinner at Cossetta's Feb. 10, 2023 Permission Form

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