Confidential Information
To best support you and your child(ren), please let us know of any physical limitations, learning challenges, special needs and/or family circumstances (recent separation, divorce, death or illness). Please contact the program director prior to the start of classes so we may learn how to support you in the care of your child(ren)’s needs and faith development. Thank you!
General Permissions Consent* Yes, I agree to the General Permissions Consent.
I request that my child(ren) be allowed to participate in Family Faith Formation programs. I hereby release and indemnify my parish, its staff, volunteers, and the Diocese of Joliet from any and all liability arising from claims of any kind or nature whatsoever from my child’s participation.
I agree on behalf of myself, my heirs, assigns, executors, and personal representatives, to hold harmless and defend Parish, Our Lady of Mercy Catholic Church, and the Diocese of Joliet, its officers, directors, agents, employees, or representatives from any and all liability for illness or death arising from or in connection with my participation.
Code of Behavior Consent* Yes, I agree to the Code of Behavior.
I acknowledge that I am representing our diocese/parish during this event, and I will represent us well. I will adhere to all Diocesan Guidelines and display responsible, mature, and respectful behavior in my words, actions, and usages.
Expectations
1. All participants are expected to arrive on time.
2. All participants are expected to demonstrate respect and common courtesy at all times. Inappropriate language/behavior/conduct will not be tolerated.
3. Socializing should always be done in public areas.
4. Dress should reflect the values of modesty and respect, and inscriptions and images on clothing should reflect Christian values.
5. The possession or consumption of any alcoholic beverages is prohibited.
6. The possession of any illegal substances is prohibited and subject to legal action.
7. Smoking, vaping, e-cigarettes, smokeless tobacco, and cannabis in any form are prohibited.
8. Weapons and/or drug paraphernalia are prohibited.
INFRACTION OF THESE RULES CAN MEAN IMMEDIATE DISMISSAL WITH NO REFUND.
I understand and agree to the Code of Behavior. I also understand and agree that at the time of an infraction requiring dismissal, l will be notified and/or I will be responsible for any and all costs related to the participants dismissal from activities and any all costs assessed by local authorities.
Videos, Photos, and Virtual Platforms Consent* Yes, I agree to the Video, Photos, and Virtual Platforms Consent
Videos and/or photos may be taken during this event. This authorization consent constitutes permission to use my child(ren)’s image in video and/or photos which may be used for future promotional efforts including the parish and /or Diocese of Joliet website.
Medical Permission Consent* Yes, I agree to the Medical Permission Consent.
I grant permission for the administration of First Aid to my child/children by the people in charge of the event and those transporting my child to and from the event as their judgement deems advisable and to make the necessary referrals to qualified physicians for the treatment of illness or accidents of a more serious nature. I understand I will be promptly notified in the event of any serious illness or accident and prior to any major surgery, except when delay of such communication would endanger life. In the case of a medical emergency, I understand that every effort will be made to contatct the parent/guardian of the participant. In the event that I cannot be reached I hereby give permission to the physicians selected by the adult staff to hospitalize, secure proper treatment for and to order injections, anesthesia or surgery if deemed necessary for my child.
If YES, please describe student(s)'s medication allergies:*
Please type NA if not applicable.
If YES, please describe student(s)'s food allergies:*
Please type NA if not applicable.
ALLERGIC TO OTHER*
Please type NA if not applicable.
OTHER CONDITIONS*
Please type NA if not applicable.