Medical Consent & Liability Waiver
This form is to be completed by the primary parent or legal guardian for any youth participating in St Edward / St Thomas Parish or Diocese of Lafayette associated events, field trips, mission trips or retreats.
The e-mail address you provide below must be accessible by only the person completing this document.
Note: If your child has prescription or over-the-counter medications, you must provide a complete list of medications taken by your child. This should include: Prescription number (if applicable), quantity received, drug strength, expiration date and dosage schedule. For over-the-counter medications, you should provide the name of medication, quantity received, drug strength, expiration date and dosage.
Adult staff/volunteers will not administer shots of any kind. If your child requires this type of medication, you are to ensure they are properly trained in self administration and coordinate meeting with staff/volunteer on proper supervision of administration prior to the event.
If your child has severe allergies and requires to have an emergency epinephrine stick, you must provide detailed information and instruction to the event coordinator prior to the event.
Page 1 of 6
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service