March for LIfe

Emergency Medical/Permission Form
I/We, as the parents/legal guardian of the above-named participant, a minor, hereby grant the Diocese of Grand Island, their 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 minor, and I/We release the Diocese of Grand Island, their staff, and volunteers from any liability.

I/We understand that this event is sponsored by the Diocese of Grand Island. I/We hereby grant permission for My/Our son/daughter to participate in this event 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, 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, 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:
Insurance Company Name*
Insurance Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Policy Number*
Phone Number*
Physician's Name*
Physician's Phone Number*
Physician's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Note any ALLERGIES:*
(including food allergies)
Note any MEDICAL CONDITIONS:*
(including mental health or pregnancy)
Note any current MEDICATIONS:*
Please indicate:*

I prefer that she/he be responsible for these medications her/himself.I prefer that the staff hold these medications and dispense according to the directions.
Date of last Tetanus Shot*

MonthDayYear
Date
Please indicate:*

I DO give permission for this minor to be given over-the-counter treatments (such as Tylenol, Tums, Sudafed, etc) if she/he experiences discomfort and requests treatment.I DO NOT give permission for this minor to be given over-the-counter treatments (such as Tylenol, Tums, Sudafed, etc) if she/he experiences discomfort and requests treatment.
Parent(s) Address if different than student address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent Alternate Number

Code of Conduct
Code of Conduct
Everyone participating in the March for Life event must agree to a “Code of Conduct.” These guidelines are necessary to make the event enjoyable for all and to avoid problems. Participants have a responsibility to themselves and others to follow these guidelines:
- Be Respectful and Safe. When participating in this event, we expect to create an environment of safety and trust. The use of our bodies, language, and humor must always honor the dignity of every person. If you jeopardize the physical or emotional safety of yourself or the group, you choose to have a parent or guardian pick you up and take you home immediately.
- Be Responsible and Honest. Participants are expected to be present at all activities on time and participate fully. Established guidelines will be observed at all times. We need to take care of the building and grounds. Any damage is to be reported immediately and involved persons are financially accountable. Emergencies that involve the health and well-being of people and/or property must be reported to adult staff immediately.
- The use of illegal drugs, including alcohol, or other illegal/harmful substances is not permitted. If you use these materials, you choose to have a parent or guardian pick you up and take you home immediately. Proper authorities will be notified. Do not bring clothing that advertises/promotes alcohol, tobacco or drug use or anything displaying messages that are offensive or contain sexual innuendo. These are contrary to the values of a Catholic event and are not acceptable.
- Observe appropriate boundaries. All participants must stay in designated areas. Males and females are lodged in separate rooms. Participants do not enter each other’s rooms unless supervised by an adult. One of our goals is to relate with everyone present; therefore, while participating in this event, exclusive relationships are discouraged. If you engage in activities contrary to these guidelines or any activities that jeopardize your safety or the safety of the group, you choose to be removed from the event. Your parent or guardian will be called to pick you up and take you home immediately.
Dress Code
In order to promote a safe, healthy and positive community experience the following dress code must be followed by all male and female participants and adult leaders. Clothing should be modest and appropriate to a youth retreat/conference setting. Clothing should not present messages contrary to the values of a Catholic event.
- All attire should be sized to fit without exposing undergarments, buttocks, stomachs or cleavage.
- Shirts must be long enough to naturally touch the top of the lower garment, with arms raised.  Shirts must cover the shoulders. No Spaghetti straps, tank tops, and halter tops or transparent/mesh clothing or shirts with revealing necklines or armholes.
- Shorts and skirts must be fingertip length when arms are resting at sides.
- No yoga pants or form-fitting pants/shorts.
- No clothing or accessories that promote drugs, alcohol or tobacco either by brand or message.
- No clothing or accessories with sexually suggestive language or messages or clothing or accessories that promote violence, criminal activity, intimidation or intolerance of others (based on religion, ethnicity, gender or lifestyle).
- Modest swimsuit appropriate for a Catholic retreat setting, No Speedo or bikini.
Parent / Participant Signature:

I/We understand and accept the guidelines and policies stated in this Code of Conduct. I will accept the consequences should my son/daughter choose to violate the code. I agree to pick up my son/daughter, should he/she choose to behave in a manner that the director and adult leaders judge to be a serious violation of this code and is contrary to the mission of a Catholic event.
Parent/Guardian Signature*

Clear
Participant Signature*

Clear
Date*

MonthDayYear
Date

Choose one*

March for LIfe Full FeesIncludes a $300 non-refundable deposit

$700.00

March for Life Non-Refundable DespositFull payment of all fees is due by December 31, 2024

$300.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

NOTE: if you have an extra box at the end of the payment section, enter your billing zip code
Should be Empty:

March For LIfe

Emergency Medical/Permission Form

Code of Conduct