Medical Release and Authorization
As Parent and/or Guardian of the named student, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.
Release authorized on the dates and/or duration of the registered class.
This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of the named minor child, in my absence.
Additional information:
Note: If you are New to Holy Spirit or have children in First Grade, you must provide a copy of each child’s Baptismal Certificate per the
Archdiocese of Detroit requirements. Copies can be obtained at the church of Baptism.