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Parental Consent for Youth to Participate in Activity, Emergency Medical Information, and Release

Parents: ______Indicated in Form_______  for themselves, heirs, executors, and administrators. The term Parent includes any Guardian authorized by law to sign this form.

Event:   All events held from July 2022 - June 2023

Parishes and Schools:   ________Indicated in Form_______, each of which are Texas non-profit corporations, including their employees, contractors, clergy, faculty agents, facilitators, and volunteers. 

Diocese:   The Catholic Diocese of Austin, a Texas non-profit corporation, including its employees, contractors, clergy, agents, facilitators, and volunteers. 

Ablaze:   Ablaze Ministries, Inc., a Texas non-profit corporation, including its employees, contractors, agents, and volunteers 

A.   The undersigned represent that they are the parents or legal guardians of Participant and have full authority under law to sign this document. 

B.   Parents grant their permission for Participant to enroll and participate in the Event.

C.   Parents acknowledge and agree that:

(1)   Participant and Parents voluntarily seek to participate in the Event; 

(2)   the Event may involve physical activity that involves risk of injury; 

(3)   Participant and Parents will abide by all policies and rules established for Event and instructions of those persons facilitating, organizing, or overseeing the Event; 

(4)   Parents and Participant are responsible for Participant’s conduct during the Event and are responsible for any damages, claims, or other costs caused by Participant or incurred as a result Participant’s conduct; and 

(5)   if Participant’s conduct is inappropriate, unsafe, or detrimental to the Event, other participants, or other persons, Ablaze or the Parish/School may suspend or expel Participant from the Event and future events. 

D.   Unless this paragraph is struck and initialed by the undersigned, Parents authorize Parish/School and Ablaze to provide over-the-counter aspirin, pain relievers, cold medicine, and other over-the-counter medications to Participant at Participant’s request if the Parish/School or Ablaze deem it reasonable to do so. Ablaze and the Parish/School will make reasonable attempts to notify Parents prior to authorizing any such over-the-counter medication. 

E.   If an emergency or a situation that is reasonably considered to be an emergency occurs, Parents authorize Ablaze or the Parish/School to seek and authorize emergency medical care to be given to Participant (for example, first aid, medication, anesthesia, or surgery). Ablaze or the Parish/School will make reasonable attempts to notify Parents prior to authorizing any such emergency care. 

F.   Parents grant Ablaze, the Parish/School and the Diocese permission: 

   (1)   to photograph and video tape Participant during the Event; and 

   (2)   to use the photographs and video tapes in publications and promotions of Ablaze, the Parish/School, or the Diocese, including but not limited to publications such as websites, newsletters, advertisements, scrapbooks, and yearbooks. 

G.   To the extent permitted by law, Parents, for themselves and for Participant, release and agree to indemnify and hold harmless the Parish/School, the Diocese, and Ablaze from any and all liability, claims, demands, and costs which may arise as a result of Participant’s participation in the Event, or which is, in any way, related to such participation. This paragraph covers loss under any theory of loss (negligence or otherwise) including but not limited to personal injury or property damage. Parents and Participant assume all risk of injury or loss to themselves or their property. 

December 8, 2023


First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive future updates from your ministry team
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Insurance

Insurance Carrier*

Insurance Policy Number*
Parish Information

Parish/School Name

Parish/School City
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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