Proclaim Your Flame Retreat (Hosted by G.L.O.W.)

PERMISSION & AUTHORIZATION FORM
  • Event: PROCLAIM YOUR FLAME RETREAT (Hosted by G.L.O.W.)
    When: 3:00 PM – 10:30 PM Saturday, February 22, 2020
    Place: Holy Family Catholic Community

    I hereby release and indemnify Holy Family Parish, its staff and its volunteers and the Catholic Bishop of Chicago, a corporation sole, from any and all liability arising from claims of any kind or nature whatsoever from my child’s participation in this event.

    In the event that the undersigned or my (our) authorized physician, cannot be reached, and in the judgment of a responsible person accompanying the group, or other appropriate staff member, there is a necessity for immediate examination and/or treatment of my (our) child, I/We hereby authorize any of the aforesaid people to obtain for my child such medical services as are deemed necessary.

  • Person to contact in case of emergency (if unable to reach parent):

  • MM slash DD slash YYYY
  • :I have read and understand the rules and agree to comply with them.

  • MM slash DD slash YYYY
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