Parent Permission and Release of Liability:
The above child is eligible to participate in above parish-sponsored event. This activity will take place under the guidance and supervision of employees/volunteers from the above parish.
If you would like your child to participate in this event, please read, complete, sign and return this form which includes your consent, as well as a full release of liability. As parent or legal guardian, you remain fully responsible for any acts of the named child during this activity.
The undersigned parent, guardian or legal representative hereby consents to the participation of the above-noted child in the event described and further consents to the conditions stated above on participating in this event, including the method of transportation. It is understood that this event will take place away from the parish grounds and that the child will be under the supervision of a designated parish employee(s)/volunteers on the stated dates.
For and in consideration of the child being allowed to participate in this event, and other valuable consideration, the undersigned parent, guardian or legal representative, on behalf of the child and the child’s parents, personal representatives, assigns, heirs, and next of kin, does hereby release and hold harmless the Diocese of St. Augustine, Bishop Erik Pohlmeier, as Bishop of the Diocese of St. Augustine, a corporation sole, Bishop Erik Pohlmeier, individually, the above- noted parish, and employees and agents of said parties engaged in this particular event, their personal representatives or assigns, from any loss or damage on account of any injury to the person or the personal property, of the child, or death, caused by negligence or otherwise, while the child is engaged in the above-stated event or in transportation to and from said event. The undersigned expressly agrees that this release, waiver and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of the State of Florida, and that if any portion of this Agreement is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
The undersigned parent, guardian, legal representative further acknowledges that he/she is authorized to enter this Agreement on behalf of the child, and the child’s parents, personal representatives, assigns, heirs, and next of kin.
Medical Release:
MEDICAL MATTERS: I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. (Of the following statements pertaining to medical matters, sign only in accordance with your wishes.)
EMERGENCY MEDICAL TREATMENT: In the event of an emergency, I hereby give permission to Diocese of St. Augustine’s employees, volunteers, or representatives to seek medical treatment for my child above named. In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Diocesan representatives or volunteers to hospitalize, secure proper treatment for, and to order injection and / or anesthesia and / or surgery for my child above named.
OTHER MEDICAL TREATMENT: In the event it comes to the attention of the Diocese of St. Augustine’s employees, volunteers or representatives that my child becomes ill with symptoms such as headache, vomiting, sore throat, fever, or diarrhea, I hereby give permission for over-the-counter medication to be administered to my child according to directions.
Photography & Media Release Form for Minor Children:
Without compensation, I hereby grant the Catholic Diocese of St. Augustine (the “Diocese of St. Augustine”), its ministries, parishes, schools and other affiliated entities, permission to record my child’s appearance, physical likeness and/or voice on videotape, on film, or digital video disk, or other means, and/or take photographs of my child.
Notwithstanding any prohibition as may be contained in Section 540.08, Florida Statutes, I hereby freely and voluntarily consent to the use, reproduction, and distribution of photographs, video recordings or other media capturing my child’s image, physical likeness, or voice for an indefinite period of time or until such time I expressly revoke my consent in writing. These materials may include, but are not limited to news, editorial content, publications, promotional materials, electronic media (websites, social media channels, podcasts, videos), and/or printed brochures.
In addition, I understand and agree that:
· The Diocese of St. Augustine, its ministries, parishes, schools, and other affiliated entities may alter, edit or modify these materials as needed, without restriction.
· The Diocese of St. Augustine retains the sole ownership and right to copyright any such materials.
· My consent is voluntary, and I waive any rights to inspect or approve the finished products or the specific use of such materials.
I agree to hold the Diocese of St. Augustine, the Bishop of the Diocese of St. Augustine, its employees and agents, and any media outlet or representatives involved in the creation of distribution of the materials harmless against claim, liability, loss, or damage caused by, or arising from any claims, demands or liability arising from or related the creation, use, production, or distribution of these materials. This Photography and Media Release Form for Minor Children is binding and applies to any claims of defamation, invasion of privacy, or rights of publicity.
I have read this Photography and Media Release Form for Minor Children before signing and fully understand the contents, meaning, and impact of this release. I understand that I am free to address any specific questions and have done so prior to signing this release.