Permission Form for Religious Education

Permission Form for Religious Education

at Saints Francis and Clare of Assisi
Name of Youth*

First NameLast Name
Name of Event*
I grant permission for the administration of First Aid to Youth Name* by the people in charge of the event, and those transporting my child to and from the program as their judgment deems advisable. I also grant permission that any/all necessary referrals to qualified physicians for treatment of illness or accidents of a more serious nature. I will be promptly notified in the event of any serious illness or accident and prior to any major surgery, except when delay in such communication would endanger life. In case of medical emergency, I understand that every effort will be made to contact the parent/guardian of the participant. In the event that I cannot be reached, I herby give permission to the physicians selected by the adult staff to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery, if deemed necessary for my child.
Date of Birth*

MonthDayYear
Date
Medication Allergy? What medication and what happens*
Any other allergies? If so, please state below*
Medication(s) presently taking*
Insurance Information
Policy in the Name of*
Insurance Company*
Identification Number and/or Social Security Number*
Authorized Physician

First NameLast Name
Physician's Number
Please enter a valid phone number.
Signature of Parent/Gurdian*

Clear
Date*

MonthDayYear
Date
Parent's Preferred Phone*
Please enter a valid phone number.
Family Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Other Phone
Please enter a valid phone number.
Emergency Contact #1 (Other Than Listed Above)*

First NameLast Name
Emergency Phone #1*
Please enter a valid phone number.
Relationship*
Emergency Contact #2 (Other than Listed Above)

First NameLast Name
Emergency Phone #2
Please enter a valid phone number.
Relationship
SS. Francis and Clare Authorization Form

General Permission
Please read and discuss with your child all items listed below.
I request that my child First Name Last Name be allowed to participate in theblank on Date at .
I herby release and indemnify SS. Francis and Clare, its staff, volunteers, and the Archdiocese of Indianapolis from any and all liability arising from claims of any kind or nature whatsoever from my child's participation in this event.
Code of Behavior

You are a representative of Christ, your parish family, and your own family. You will conduct yourself appropriately at all times, in the manner in which you speak and present yourself, your actions toward others, their person and/or property. You are expected to display mature and responsible behavior which has been the trademark of Catholic youth throughout the world.
General Expectations:

1. Participants are expect ot arrive on time.
2. Participants are expected to demonstrate common coutesy, respect, and dignity for all persons, places, and things at all times. Inappropriate language/behavior will not be tolerated.
3. Socializing will be done in public areas
4. Dress will reflect the value of modesty. Writing on clothing should reflect Christian values
5. The possession and/or consumption of any alcoholic beverage and/or the possesion/use of any illegal drug is not permitted.
6. Smoking is not permitted
7. Weapons and/or drug paraphernalia are not permitted.
8. If under the age of 18, prescription drugs will be given to an adult for storage and distribution
9. Infraction of these rules and other codes of inappropriate behavior can mean immediate dismissal without refund. Parents will assume all monetary responsibility for any damage that their son/daughter may incur against any person, and/or property. Parents will also assume monetary responsibility for any/all necessary transportation incurred through expulsion
10. Participants will be resonsible to local authorities.

I understand and agree to this Behavior Code. I also understand and agree that my parents/guardians may be notified at the time of infraction, as deemed appropirate by the parish staff and/or adult volunteers. Parents or guradians will be immediately notified and will be required to make any/all necessary arrangements in the case of infractions requiring explulsion and the physical removal and return of participant to parental/guardian care. Parents/guardians will be responsible for any/all costs incurred by the participants.
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Permission Form for Religious Education

Insurance Information

SS. Francis and Clare Authorization Form

Please read and discuss with your child all items listed below.

Code of Behavior