Office of Faith Formation
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KY- TN Province Meeting
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Office of Faith Formation
I'M NEW
NEXT STEPS
NEED HELP?
World Youth Day
World Youth Day Donations
Eucharistic Revival
Ministries
Middle School Ministry
High School Ministry
Young Adult Ministry
Adult Formation
Liability Forms
Image Release Form for Minors
KY- TN Province Meeting
Marriage and Family
Engaged Couple Retreats
Together in Holiness Conference
Natural Family Planning
Life Issues
Marriage Enrichment
Resources
Resources for Teenagers
Resources for Young Adults
Resources for Adults
Resources for Discernment
SEARCH Liability Form
Ministries
Middle School Ministry
High School Ministry
SEARCH Retreat for Teens
SEARCH Payment
Leadership Team Application
SEARCH Liability Form
Youth Leadership Workshop
Young Adult Ministry
Adult Formation
Liability Forms
Image Release Form for Minors
KY- TN Province Meeting
Parental/ Guardian Consent Form, Liability Waiver and Medical Information
The maximum number of form submissions has been reached. This form is currently not available.
Participant Last Name
REQUIRED
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Participant First Name
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Participant Date of Birth
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Street Address
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City
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State
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Zip
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Home Phone
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Parent/ Guardian's Name
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Parent Cell Phone Number
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Language Spoken by Parent
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Second Parent/ Guardian's Name
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Second Parent/ Guardian's Cell Phone Number
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Language Spoken by Second Parent
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Other Number Where Parent/ Guardian Can Be Reached During The Event
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Emergency Contact Name
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Emergency Contact Phone Number
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Language Spoken by Emergency Contact
REQUIRED
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In consideration of the program in which my son/daughter will participate, I, as parent/ guardian of my son/ daughter, do hereby agree to allow my son/daughter to accompany the Diocese of Nashville's Office of Faith Formation to the SEARCH Retreat at Camp Marymount in Fairview, TN. I understand that transportation is not provided to or from this event.
My child must comply with all Diocese of Nashille's rules and procedures. By granting this permission, I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend Diocese of Nashville's Office of Faith Formation, its officers, directors, employees, and agents, and the Diocese of Nashville, its employees and agents, chaperones, or representatives associated with the event, from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the parish, its officers, directors, and agents, and the Diocese of Nashville, its employees and agents and chaperones, or representatives associated with the event for reasonable attorney's fees and expenses which may incur for any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the parish/diocese.
I have read the above consent
REQUIRED
I agree
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Which SEARCH retreat will the participant be attending
REQUIRED
(Select One)
373- September 9-11, 2022
374- November 11-13, 2022
375- December 2-4, 2022
376- March 24-26, 2023
377- April 28-30, 2023
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Insurance Information. Does the participant have current medical insurance?
REQUIRED
No, I do not carry medical insurance at this time
I do carry medical insurance at this time
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Insurance Carrier
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Name of Insured
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Insurance Policy Number
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Family Doctor
REQUIRED
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Family Doctor Phone Number
REQUIRED
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My child has permission to take taking the following prescription medications while at the event. Please list medication name, dosage, and frequency
Does your child have any medical issues or allergies we should be aware of?
REQUIRED
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Does you child have any dietary restrictions?
First-Aid Consent
REQUIRED
I hereby grant permission for non-prescription (including but not limited to acetaminophen, ibuprofen, throat lozenges, cough syrup, Benadryl, etc.) to be given to my child if appropriate.
No medication of any type can be administered to my child unless the situation is life-threatening or emergency treatment is required.
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In the event of an emergency, I hereby give permission to transport my child to a hospital/clinic for emergency medical or sugical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency, if you are unable to reach me at the above numbers, please contact the emergency contact above.
I have read the above statement
REQUIRED
I agree
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In the event the participant does not have insurance, payment in full for medical care becomes the responsibility of the participants parent/guardian.
I have read the above statement
REQUIRED
I agree
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Participant- I agree to abide by any/all policies established for this event/activity. Should I not be able to maintain the guidelines and expecations of the adults and my peers, I understand there will be consequences for my actions, including being removed from the activity and being sent home at my parent/guardians expense.
I have read the above policy
REQUIRED
I agree
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Parent/ Guardian -- I fully understand the foregoing statements and sign this Medical Information and Consent Form knowingly, freely, and willingly. (Please type full name below stating the above information is true).
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