Parent Permissions Mariapolis 2025

Parent /Guardian Permissions

For all children under 18 who will attend the Mariapolis
To complete this form, you will need the child's health insurance information.

This MUST be completed by a parent/legal guardian of the child. Thank you!
Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age at time of Mariapolis*
Gender*

BoyGirl
Home Phone Number*
Child's Home Address*
Medical and Health Information

In case of an emergency, this info is very important
Insurance: Enter NA if a section is not applicable*
List any food and other allergies
List and explain any injury or sickness the child will be treated for during the Mariapolis
List and explain any physical handicap or illness that will prevent the child from participating in normal rigorous activity.
List any medications the child will be taking during the Mariapolis and reason for the medication
Epi-Pen and Inhalers

The Minor and his/her parents/guardians have been instructed in self-administrationThe Minor may carry an inhaler or Edp-Pen and self-administer
Parent/Legal Guardian Information
Parent/Guardian Full Name*
Parent/Guardian Email*
We will use this for communications about this child
Parent/Guardian Phone*
This will be used for your emergency contact during the Mariapolis
Additional Contact*
Will a parent/legal guardian be attending the Mariapolis with this child?*

Yes, for the entire timeYes, for some of the timeNo

Child Attending as a Guest
Any child attending the Mariapolis at any time that their parents are not, needs to be under the supervision of a designated adult. Read areas below for this host's responsibilities.
Designated Adult Supervisor*

First NameLast Name
Relationship to the child*
Designated Adult Phone*
In case of emergency, we will use this phone # for the host during the Mariapolis
Designated Adult Email*
Transportation
Transportation to the Mariapolis*

Transportation

For activities during the Mariapolis
Medical Permissions
Non-Prescription Medications and other medical treatment

In the event that the Minor becomes ill with symptoms such as headache, vomiting, sore throat, fever, or diarrhea, do you grant permission for supervisors to give the Minor non-prescription medication, such as acetaminophen, throat lozenges, cough syrup, or antacid?
Non-Prescription & Other Medical Treatment*

Yes, I give permission for non-prescription medicinesNo, I wish to be contacted first
Other Permissions
Parent/Legal Guardian Signature*

Clear
Typed Parent/Legal Guardian Signature*

First NameLast Name
Date*

MonthDayYear
Date
By entering my full name and signature above, I attest I am a parent/legal guardian of {primaryContact98} and that this constitutes my legal siganture on this form and information.
¹ For all those under 18 years of age or the age defined as a minor in the state, province, or territory in which the event(s) is taking place.

² As used herein, the term “Minor” means any minor individual for whom the signing party maintains legal guardianship.
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Parent /Guardian Permissions