In the event that the undersigned cannot be reached and in the judgment of:

Nathan Johnson - Director of Faith Formation & Youth Ministry

or other person responsible for the program/group, or appropriate staff member, there is a necessity for immediate examination and/or treatment of my (our) child(ren) listed above, I (we) hereby request and authorize any of the aforesaid personnel to obtain for my (our) child(ren) such medical services as are deemed necessary. I (we) agree to assume the financial responsibility for any diagnosis/treatment and for medication deemed necessary.

Date or Dates for which release is intended: All classroom dates & scheduled events for the 2022-23 year