If you would like your youth to participate in this event, please sign the following statement of consent and release of liability. As a parent or legal guardian, you remain fully responsible for any legal responsibility which may result from any personal actions taken by your youth.

 In consideration for the opportunity for my child to participate, and fully recognizing that such an undertaking involves an element of risk, we assume all risks and hazards incidental to such participation and do hereby release, absolve, indemnify and agree to hold harmless the Diocese of Pensacola-Tallahassee and St. Ann Catholic Parish, and their employees, agents, volunteers, and other persons acting on their behalf. Neither the Diocese of Pensacola-Tallahassee, St. Ann Catholic Parish, nor said agents, employees, or volunteers, shall be held financially responsible for any injury, illness or death incurred as a direct or indirect result of this activity. We the undersigned have read this release and understand all its terms and execute it voluntarily and with full knowledge of its significance.

 
EMERGENCY MEDICAL TREATMENT: In the event of an emergency, I/we hereby authorize the Diocese of Pensacola-Tallahassee, and St. Ann Catholic Parish, through its authorized representatives, to transport my child to a hospital or other doctor’s office or medical facility for emergency medical attention. I/We additionally authorize such representatives of the Diocese and/or School to obtain and give consent to whatever medical treatment the representative deems necessary, including the administering of anesthetic and surgery, and do hereby release the Diocese and St. Ann Catholic Parish, and their authorized representatives from any and all claims which may arise from the above-referenced obtaining and consenting to medical treatment. I/We wish to be advised, if possible, prior to the providing of any non-emergency medical treatment by any physician or hospital. If parents are not able to be contacted, we will contact the emergency contact previously noted.

Diocesan Ministry, Organization, Parish or School

(This section must be completed by diocesan ministry, organization, parish or school.)

Ministry / Parish / School / Organization communicates via:

Cellular number or Text Messaging Service: Flocknote, Youth Director Personal Cell Phone #

E-mail address: youth@stanngulfbreeze.org

Social networking site(s): Instagram, Facebook, Flocknote Messaging Service

Name (parent/guardian): {parent}

Minor Child: {childsName}