Please Complete One Form for Each Student

Parent Information

Medical / Special Needs Information

Emergency Contact and Insurance Information

In the event of an emergency, I hereby give my permission to the staff of The Catholic Church of St. Gabriel to seek emergency medical transportation and/or treatment for my child named above. I will be responsible for all costs incurred. If I cannot be reached, contact:

Insurance Information

Consent and Liability Waiver

As the parent/guardian of the above-named child, I do hereby give my approval for him/her to participate in the Religious Education classes and events, including retreats and off-site events that are sponsored by the Catholic Church of St. Gabriel. I do hereby, for myself, my heirs, executors, and administrators, waive, release, absolve, indemnify and agree to hold harmless any and all adults who chaperone, also the Archdiocese of Atlanta and its representatives, successors, supervisors, sponsors, organizers and participants for any injuries in connection with the program named above. I likewise release from responsibility any person transporting my child to and from any of the activities.

I understand that clicking the Submit button constitutes a legal signature confirming that I acknowledge and agree to the above.

Photograph, Video and Communications Release

Please indicate below whether the Religious Education department has permission to use photographs, images, or videos of your child:

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