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Youth Evangelization and Discipleship Contact:

Brad Bursa
Director
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100 E. Eighth St.
Cincinnati, OH 45202-2193
Phone: (513) 421-3131 ext. 2741
Fax: (513) 421-1582

Permission and Release Form

Archdiocesan Policy: Guidelines for Youth Activities

2017 Child Permission/Release Form (.pdf)
Editable, MS Word version of the 2017 child form
2017 Adult Permission/Release Form (.pdf)
Editable, MS Word version of 2017 adult form
 En Español
Autorización y liberación de responsabilidad forma (.pdf)
Versión Editable de la forma (.doc)
(with thanks to Fr. Samuel Gonzalez)

Parental rights, good administration and youth protection dictate that the appropriate sharing of information and granting of permissions be involved when youth participate in parish-based activities.

The Archdiocese of Cincinnati has developed sample forms to satisfy these needs (see above). One is for children under 18 years of age. The adult form is for individuals who are 18 years of age or older, legally adults, who are being treated as children for the purposes of the decree (still in high school). While these particular forms are not mandated for use in the parishes of the Archdiocese, they are recommended.

Whether the particular recommended forms are used or not, the following written documentation is required in some form, whether a child is registering for an ongoing program or for a single activity.

1. Name of student

2. Name of parish/school

3. Name of adult in charge

4. Date of activity or regular time for program

5. Location of activity

6. Telephone number where youth can be reached in case of a family emergency

7. Starting time or date, ending time or date

8. General description of program or activities which are involved

9. Method of transportation (if any)

10. Cost (if any)

 

In addition to providing this information to the parents, the form must provide a place for the parent to give permission for the child to participate in the program or activity and to receive emergency medical care (including pertinent medical information), if the activity will take the youth some distance from home.In addition there must be a release of the Archdiocese, parish and school from liability in the event of accident or injury to the youth utilizing the following language:

I, the lawful parent or guardian of (the “child”), give permission for my child to participate in the activity described on the Activity Information Form and release from all liability and indemnify the Archdiocese of Cincinnati, the Archbishop of Cincinnati (“the Archbishop”), both individually and as trustee for the Archdiocese of Cincinnati, and all parishes and schools within the Archdiocese, and their officers, agents, representatives, volunteers, and employees from any and all liability, claims, judgments, cost or expenses, including attorneys’ fees, arising out of any injury or illness incurred by my child while participating in or traveling to or from the activity.

A parent or legal guardian must provide for the above by written signature and date and also supply a telephone number where the parent can be reached in case of an emergency involving the child.