Permission, Release, and Authorization to Seek Medical Treatment
1. By checking this box, I give permission for my child to participate in the activity described in the Activity Information form and release from all liability and indemnify the Bishop of Columbus, both individually and as trustee for the diocese, all parishes and schools within the diocese, and their respective officers, agents, representatives, volunteers, and employes, the Bishop of Columbus individually and as trustee for the Diocese of Columbus, Our Lady Queen of Apostles parish, and all parishes/schools and their representatives from any and all liability, claims, judgments, cost and expenses, including attorney's fees, arising out of any injury or illness incurred by my child while participating in or traveling to or from the activity and further agree not to bring or prosecute or allow to be brought or prosecuted (including but not limited to prosecution through subrogation) in my name, or on behalf of my child, any claims, lawsuits, or actions against the Bishop, the Diocese, and their officers, agents, representatives, volunteers, and employees.
2. I further understand that my child's participation in this activity is purely voluntary and is a privilege and not a right, and that my child, and I on behald of my child, agree to my child's participation in the Activity in spite of the risks.
3. I agree to instruct my child to cooperate with the bishop or his agents in charge of the activity.
4. I appoint the bishop or his agents who are acting as leaders of the activity to seek medical treatment of my child in the event of any injury, illness, or medical emergency occurs during the activity or related travel. I understand that the agents of the bishop will make a reasonable attempt to contact me as soon as possible in the event of a medical emergency involving my child.
5. I agree that the bishop or his agents may use my child's portrait or photograph or video for promotional purposes, website and office functions, and use social media.
6. This acknowledgement and release is intended to be as broad and inclusive as permitted by the law of the State of Ohio, and if any portion hereof is declared invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This acknowledgement and release shall be construed in accordance with the laws of the State of Ohio, except for the choice of law provisions thereof.
I have carefully read and understand and accept the terms and conditions stated herein and acknowledge that this Permission, Release and Authorization to Seek Medical Treatment shall be effective and binding upon me, my child, and my own and my child's personal representative or estate, assigns, heirs, and next of kin, and that I have signed this agreement of my own free will.
By choosing "I Agree", you accept the terms and conditions that have been stated above. A hard copy of this may be obtained from the parish office at Our Lady, Queen of Apostles (285 W. Water Street).