This consent form gives permission to seek whatever medical attention is deemed necessary by any agents of St. Peter’s Anglican Cathedral (“the Cathedral”) and releases the Cathedral and its agents of any liability against personal losses of named child.
I, the undersigned have legal custody of the student named above, a minor, and have given our consent for him/her to attend events being organized by the Cathedral.
I understand and acknowledge that there are inherent risks involved in any ministry, athletic, church event or events in general and I hereby release, hold harmless and agree to indemnify the Cathedral, its priests, employees, agents and volunteer workers from any and all claims, damages, losses, suits, actions, including but not limited to exposure or claimed exposure to illness, virus or sickness, brought by any person or entity whatsoever that may be claimed to have accrued during or associated with or related to my child’s involvement.
In the event that he/she is injured and requires the attention of a doctor, I consent to any reasonable medical treatment as deemed necessary by a licensed physician or dentist selected by any agents of the Cathedral including, but not limited to, hospitalization, injections, anesthesia, or surgery for my child. In the event treatment is required from a physician, dentist and/or hospital personnel designated by the Cathedral, I agree to hold such person free and harmless of any claims, demands, medical bills or charges of any kind or nature, or suits for damages arising from the giving of such consent. I also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further, I affirm that the health insurance information provided above is accurate at this date and will, to the best of my knowledge, still be in force for the student named above. I also agree to bring my child home at my own expense should they become ill, if deemed necessary for any reason (including misbehavior) by any agent of the Cathedral.
I understand and acknowledge that while myself, family and/or child(ren) are involved in Cathedral activities, we may be a part of photographs or video recorded by representatives of the Cathedral. I hereby release and give permission to the Cathedral to publish any such image of myself, my family, child(ren) in any combination of still photograph or video format for advertisements, including the website, newspaper, or images represented in theaters. I authorize the Cathedral to publish names and/or photos of my child(ren) in church publications and through various Cathedral media.
This Release shall remain in full force and effect until rescinded by a written instrument signed by me and delivered to the Cathedral. I give permission for the Cathedral to rely on the information I have provided herein until such time as I have amended, modified, or revised this information by a written instrument signed by me and delivered to the Cathedral. I understand and acknowledge that is it my sole duty and responsibility to inform the Cathedral of any and all changes to the information I have provided herein.