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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.
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.
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
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, 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.
(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.
3b. This
power of attorney shall lapse automatically upon completion of the activity
and related travel.
4.
I agree that the Archbishop or his agents may use my child’s portrait
or photograph for promotional purposes, website and office functions.
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)______________
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
For the Archdiocesan Policy and Activity
Release Form click on this line!
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