Emergency Medical Release & Permission Form Logo
  • Emergency Medical Release & Permission Form

    All Saints 2024 - 2025
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  • Please complete this form and return it at the first Religious Ed class. It will remain on file with the Youth Ministry for the 2018 - 2019 school year.

    (The purpose of the following medical release form is to enable parents and gurdians to authorize the provision of emergency treatment for minors who become ill or injured under All Saints Parish and High 5 Youth Group authority, when parents and guardians cannot be reached.)

    • Medical Information 
    • In the event reasonable attempts to contact the parents listed above using the "Home Phone" or "Cell Phone" listed or reasonable attempts to contact the "Other Contact" using the "Other Contact Phone" have been unsuccessful, I herby give my consent for the administration of ay treatment deemed necessary to:

    • **NOTE**  In the event that the designated practitioner is not available, permission is granted to another licensed physician or dentist.  

      **NOTE**  If hospital designated above is deemed to far away by medical professionals, permission is given to transfer minor to the nearest hospital.

       

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    • Insurance Information 
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    • Authorization Information 
    • Also, as parent or legal guardian, I give "Youth Name" listed above my permission to participate in High 5 Youth Ministry activities and trips.  I agree to assume full responsibility for bodily injury, loss of personal property, and expenses therof, if they should occur as the result of my youth's negligence.  In consideration for my youth's participation, I further agree not to hold All Saints Parish, the Coordinator of Youth Ministry or Youth Ministry Volunteers to claims of ordinary negligence.  I also agree that pictures taken at functions sponsored by All Saints Parish can be posted on the Parish Website.

    • Clear
    • Signature of Parent or Legal Guardian: _______________________________________________

    • If you will be printing this form and returning it to your child's PRE class, please sign on the line above.

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    • Additional Youth Info 
    • Please use seperate forms for each high school youth.  You can print the form using the "Print Form" button below, then change only the information required for the next student.  Or you can click the "Clear Form" button and start from the beginning.

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    • Parent Volunteer Information

    • Please call the office at (419) 595-2567 or email Kathy Reinhart at kathy.allsaints@gmail.com if you have any questions, comments, or concerns.

      Thank you for all you do to make things happen for our youth.  You are the first and primary youth minister in their life and what a privilege it is for us that they are involved in parsh life and youth ministry. 

      May God bless you and your family abundantly.

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