VBS Emergency, Permission & Release Form (2025)

Vacation Bible School (2025)

These forms will be kept on file for your child. Please fill out an individual set of forms for each child in your household who will be participating or volunteering.
St. Andrew, St. Elizabeth Ann Seton and St. Veronica Vacation Bible School Emergency, Permission & Release Form
I, the parent or lawful guardian of First Name* Last Name* (the "Child"), give permission to participate in virtual or in person youth meetings and release from all liability and indemnify St. Andrew, St. Elizabeth Ann Seton and St. Veronica, the Archdiocese of Cincinnati (the "Archdiocese"), the Archbishop of Cincinnati (the "Archbishop), both individually and as trustee for the Archdiocese, and all parishes and schools within the Archdiocese, their respective officers, agents, representatives, volunteers, and employees, and all priest, bishops, clergy and religious of the foregoing entities, from any and all liability, claims, judgements, damages, costs and expenses, including attorneys' fees, arising out of any injury, death, illness, or infectious disease, such as MRSA, influenza, or COVID-19, (including any injury, death, illness, or infectious disease caused by the negligence of School, the Archbishop, the Archdiocese, any parish or school within the Archdiocese, and/or their respective officers, agents, representatives, volunteers or employees) incurred by my child while participating in or traveling to or from the Activity and further agree not to bring or prosecute or allow to be brought or prosecuted (including buy not limited to prosecution through subrogation) in my name, or on behalf of my child, any claims, lawsuits, or actions against School, the Archbishop, the Archdiocese, all parishes and schools within the Archdiocese, and their respective officers, agents, representatives, volunteers and employees.

I further understand that my Child's participation in the Activity is purely voluntary and is a privilege and not a right, and that my Child, and I on behalf of my child, agree to my Child's participation in the Activity in spite of the risks.

I agree to instruct my Child to cooperate with the Archbishop or his agents in charge of the activity.

I appoint the Archbishop or his agents who are acting as leaders of the Activity to seek medical treatment for my Child in the event any injury, illness, infectious disease, or medical emergency occurs during the Activity or related travel, I understand that the agents of the Archbishop will make a reasonable attempt to contact me as soon as possible in the event of a medical emergency involving my Child.
Please indicate*
that the Archbishop or his agents may use my Child's portrait or photograph for promotional purposes, website, and office functions.
Please indicate*
that the Archbishop or his agents may use social media and technology to communicate to my Child regarding ministry related activities.
This acknowledgement and release is intended to be as broad and inclusive as permitted by the law of the State of Ohio, and if any portion hereof is declared invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This acknowledgement and release shall be construed in accordance with the laws of the State of Ohio, except for the choice of law provisions thereof.

School, the Archdiocese, the Archbishop and their agents, employees, and colunteers shall haveno liability whatsoever in the event the Activity is cancelled due, in whole or in part, to any present of future pandemic, epidemic, widespread disease or illness, public health concern, or circumstances arising therefrom, or from actions taken by any governmental or municipal authority to prevent, avoid, or mitigate the impacts thereof, irrespective of whether formally declared as a "pandemic", "epidemic", or the like by any public health entity of governing body.
I have carefully read and understand and accept the terms and conditions stated herein and acknowledge that this Permission, Release and Authorization to Seek Medical Treatment shall be effective and binding upon me, my Child, and my own and my Child's personal representative or estate, assigns, heirs, and next of kin and that I have signed this agreement of my own free will.
Signature*

Clear
Date*

MonthDayYear
Date

2025 Contact & Medical Information

(Completed by parent/guardian)
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent Email*
example@example.com
Parent Phone Number*
Please enter a valid phone number.
Emergency Contact*

First NameLast Name
Emergency Contact Phone*
Please enter a valid phone number.
Home Church*
Child Birthdate*

MonthDayYear
Date
Child's Allergies*
Child's Medications
Chronic conditions (e.g. epilepsy, diabetes, etc)
Medical Insurance Company*
Medical Insurance Policy Number*
Member Name*

First NameLast Name
Member Phone*
Please enter a valid phone number.
Member Date of Birth*

MonthDayYear
Date
Family Doctor
Doctor Phone number
Please enter a valid phone number.
I acknowledge that this information is correct and will update the Parish Office should anything change.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Vacation Bible School (2025)

St. Andrew, St. Elizabeth Ann Seton and St. Veronica Vacation Bible School Emergency, Permission & Release Form

2025 Contact & Medical Information