DIOCESE OF MONTEREY PERMISSION WAIVER, RELEASE AND CONSENT FOR TREATMENT FORM FOR PARISH/SCHOOL ACTIVITY/EVENT
To the Parent/Legal guardian: This is an agreement releasing the sponsoring parish/school before, during and after the activity/event. This form is also authorization for the adult supervisor to consent to any medical care needed by the minor if the situation should arise. This agreement releases the ROMAN CATHOLIC BISHOP OF MONTEREY, CALIFORNIA, A CORPORATION SOLE, also known as the DIOCESE OF MONTEREY which will be referred to as the DIOCESE OF MONTEREY throughout this document, from any claims that the parent/guardian may have against the DIOCESE OF MONTEREY.

Activity/Event:  San Agustin Parish – Faith Formation Classes/Activities from October 2021 - October 2022

Mode of Transportation:  Parents are responsible for transportation to and from events unless student is a licensed driver.

As the parent or legal guardian of the above named student, I hereby give my permission for my child/teen to participate in the youth activity named above. I agree to direct my children to cooperate and conform with directions, instructions and rules established by the chaperone, parish or diocesan personnel responsible for the above mentioned youth activity.

In exchange for permitting my children to participate in the above named activity, to the extent permitted by law, I waive all claims for damages which I may have or which may hereafter accrue to me or my child/teen against the DIOCESE OF MONTEREY, for death, personal injuries, and losses or injuries to property, real or personal, caused by or arising out of the above named activity/event. It is further understood and agreed that this agreement, waiver and release is to be binding on my successors, heirs and assigns.

In addition, to the extent permitted by law, I release and discharge in advance the DIOCESE OF MONTEREY and its officers, agents, employees, from any and all liability relating to the above named activity.

I agree and understand that transportation may be provided in such form and at the discretion of the DIOCESE OF MONTEREY.

My child/teen is physically fit and capable of participation in this event.

I authorize a representative of the DIOCESE OF MONTEREY into whose care the above named minors has been entrusted, to consent to and permit any and all necessary medical services for my child/teen to be rendered to him/her under the general or special supervision and upon the advice of a physician and surgeon licensed under the surgical diagnosis or treatment and hospital care rendered to my child/teen by a dentist licensed under the provisions of the Dental Practice Act. I hereby give the representative of the DIOCESE OF MONTEREY permission to use his/her judgment obtaining medical services. I agree if medical services are required for my child/teen, the DIOCESE OF MONTEREY will not be responsible for any medical expenses.

It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and power on the part of the above mentioned diocesan representative to give specific consent to any and all such diagnosis, treatment or hospital care that the above mentioned physician in the exercise of his/her best judgment may deem advisable.

I here by authorize any hospital which has provided treatment to the above named minors pursuant to the provisions of Family Code section 6910 to surrender physical custody of such minors to the diocesan representative upon the completion of treatment. This authorization is given pursuant to Health and Safety Code section 1283.

This authorization shall be in effect during all time that my child/teen is under the supervision of the DIOCESE OF MONTEREY for the above mentioned event and shall remain effective until minor returns from the event and is no longer under the supervision of the DIOCESE OF MONTEREY.

This waiver and release form is signed in order to participate in the above named event for my child/teen’s own personal enjoyment and benefit and is done freely with full knowledge of the risk and dangers that are or may be involved. I, the parent/guardian, have read this release and understand all of its terms. I execute this voluntarily and with full knowledge of its significance. I have discussed the above with my child/teen and he/she is aware of and understands the importance of following all rules set out by the supervisor(s).