Medical Authorization / Release of Liability:
I/We, as the parents/legal guardian of the above-named participants, hereby grant the Diocese of Grand Island, their staff, parish, parish staff, and volunteers permission to transport this minor to an emergency medical or health care facility for immediate treatment and/or consultation, if deemed necessary. I/We understand that I/we will be notified of any emergency situation immediately. I/We give authorization to the attending physician, dentist, or medical personnel for any required immediate treatment in the event that I/we cannot be reached at the time of the emergency. I/We agree to be financially responsible for any and all medical expenses and/or treatment costs and all related services provided to the above mentioned participants, and I/We release the Diocese of Grand Island, their staff, parish, parish staff, and volunteers from any liability.
I/We understand that this event is sponsored by the Diocese of Grand Island but is a program through my parish. I/We hereby grant permission for My/Our son/daughter to participate in Totus Tuus and accept full responsibility for any legal or financial consequences which may result from any personal actions (ie. damage to property or other participants/staff/volunteers) taken by My/Our son/daughter, and I/We agree to hold the Diocese of Grand Island, their staff, parish, parish staff, and volunteers harmless with respect to any actions or claims that may be made in connection with personal actions taken by My/Our son/daughter. I/We also grant permission for the Diocese of Grand Island, their staff, parish, parish staff, and volunteers to use photos and videos of My/Our son/daughter for publicity/marketing purposes.
I/We authorize the release of information to My/Our insurance company and family physician.