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Archdiocesan Policy: Guidelines for Youth Activities    

Legal & Liability Issues FAQ

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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 a sample form to satisfy these needs (pp. I-4, I-5).  While this particular form is not mandated for use in the parishes of the Archdiocese, it is recommended.  

Whether the particular recommended form is 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 reverse and release from all liability and indemnify the Archbishop of Cincinnati (“the Archbishop”), both individually and as trustee for the Archdiocese of Cincinnati and all parishes within the Archdiocese, and their officers, agents, representatives, volunteers, and employees from any and all liability, claims, judgments, cost or expenses, including attorney 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.

 

ARCHDIOCESE OF CINCINNATI

PERMISSION, RELEASE AND MEDICAL POWER OF ATTORNEY   (rev. 6-2006)

1.             I, the lawful parent or guardian of                                                              (the “child”), give permission for my child to participate in the activity described on the reverse and release from all liability and indemnify the Archbishop of Cincinnati (“the Archbishop”), both individually and as trustee for the Archdiocese of Cincinnati and all parishes within the Archdiocese (the "Archdiocese"), and their officers, agents, representatives, volunteers, and employees from any and all liability, claims, judgments, cost or expenses, including attorney 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 Archbishop, the Archdiocese, and their officers, agents, representatives, volunteers and employees.  

  2.           I further understand that my Child’s participation is purely voluntary and is a privilege and not a right, and that my Child, and I on behalf of my Child, elect to participate in spite of the risks.

  3.              I agree to instruct my child to cooperate with the Archbishop or his agents in charge of the activity.

  4.           I appoint the Archbishop or his agents who are acting as leaders of the activity as my attorney in fact to act for me in my name and my behalf, in any way that I would act if I were personally present, with respect to the following matters if any injury, illness or medical emergency occurs during the activity or related travel:  

                (i)   To give any and all consents and authorizations to any physicians, dentist, hospital or other persons or institutions pertaining to any emergency medications, medical or dental treatments, diagnostic or surgical procedures or any other emergency actions as our attorney shall deem necessary or appropriate for the best interest of the child.

                (ii)  I understand that the agents of the Archbishop will make a reasonable attempt to contact me as soon as possible in the event of a medical emergency involving my child.  

5.             This power of attorney shall lapse automatically upon completion of the activity and related travel.

6.             I agree that the Archbishop or his agents may use my child’s portrait or photograph for promotional purposes, website and office functions.

7.             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 Medical Power of Attorney 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.

Signature of Parent or Guardian__________________________       Date       /        /           

Address_______________________________ City_______________________ Zip ________

Place of Employment___________________________________________________________

Address_______________________________ City _______________________ Zip________

Phone: (w) _____________(h)______________ 

Emergency Contact ________________________ Phone: (w)_____________ (h)____________

*****************************************************************************

Medical Information — Completed by Parent or Guardian — Please Print  

Child’s Name                                                                              Birth date____________________

Child's Social Security # * _________________________________

Allergies______________________________________________________________________

Medications ___________________________________________________________________ 

Chronic Conditions (e.g. epilepsy, diabetes)                                                                                           

Medical Insurance Co.                                                                       Policy No.                                   

Member's Name__________________________  Phone: (h) ____________ (w)______________

Member's Birth Date  ____/____/____  Member's Social Security # * _________________________

Family Doctor____________________________ Phone _________________________________

*Social Security number is optional; however, please note that some hospitals WILL NOT treat without it.
(See reverse for activity information º)


ACTIVITY INFORMATION

Completed by Church Agency - Please Print

(As a convenience to parent(s) or guardian(s), a duplicate copy of this information may be attached so as to be retained by them; also any additional information may be attached to further inform them of specific scheduling details, additional activity information, etc.)

A.        On-Going Program

Church Agency                                                              Program or Group ________________

Starting Date                             Ending Date                   Registration Fee _________________

Usual Location                                             Usual day and time ________________________

Routine Activities:___________________________________________________________

Group Leader                                                          Telephone No.                                              

Other Information____________________________________________________________

_____ Check here if any additional information is attached.  (Note: any additional activity information (e.g. schedule, list of specific activities, etc.) may be attached to further inform parents(s) or guardian(s).

B.        One-Time Activity

Church Agency                                               Activity                                                                       

Location                                                           Emergency No.                             Cost                    

Starting Date and Time                                           Meeting Place                                                     

Ending Date and Time                                            Meeting Place                                                     

Activities Involved______________________________________________________________ 

Type of Transportation (if any)                                                                                                          

Group Leader                                                    Telephone No.                                                            

Other Information                                                                                                                              

          Check here if any additional information is attached.  (Note: any additional activity information (e.g. schedule, list of specific activities, etc.) may be attached to further inform parents(s) or guardian(s).

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For the Archdiocesan Policy and Activity Release Form click on this line!
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