-
Media
-
Parent/Guardian Information
-
-
-
-
-
Emergency Contact Information
If we are unable to reach the parent/guardian whom should we contact
-
-
-
Child/Participant Information
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Liability and Medical Release
-
I hereby release and agree to hold harmless the Diocese of Rapid City and the Cathedral of Our Lady of Perpetual Help, any of its staff, advisers, chaperones, or persons connected with the Cathedral of Our Lady of Perpetual Help from any liability, claims, and/or damages for personal injury, property loss or damage, or expenses arising from participation in any event at the Cathedral of Our Lady of Perpetual Help.
In the event and within reasonable measure, If I and our emergency contact are unable to be contacted. I hereby grant permission for appropriate supervisors to seek appropriate medical care on my behalf until I am able to be present, including but not limited to emergency surgery; and, we fully and completely assume responsibility for all medical bills. *
-
Social Media Release
-
I, hereby give the Diocese of Rapid City/Cathedral OLPH, its successors and assigns and those acting with authority, the unqualified right and permission to reproduce, copyright and circulate pictures and/or video of my child produced and filmed by the Diocese of Rapid City and/or Cathedral OLPH Church. I understand I will be contacted in advance for permission to publish my child’s name.
I hereby warrant that I am free to give this permission. I further warrant that the information I have provided is to the best of my knowledge, true and accurate.
-