Children’s Christmas Nativity Program

Participant's Name
Child's Name:
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Grade:
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Child's Name:
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Grade:
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Child's Name
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Grade:
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Parent Information
Parent Name:
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Parent Cell: --
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Phone: --
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Parent Address:
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Parent E-mail:
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Consent and Release
CONSENT AND RELEASE OF LIABILITY FOR USE OF MINOR’S LIKENESS AND OTHER INFORMATION
I (We) the parent(s) and/or guardian(s)hereby grant consent for Immaculate Conception Church (“Parish”), and/or its agents to record (in writing or otherwise), photograph, audiotape, or videotape my minor child’s name, image, likeness, spoken words, student work, and/or performance, in any form, and to display, release, exhibit, publish, or distribute the same, or any part thereof, for the purpose of and in connection with any material that may be created by or on behalf of the Parish including, without limitation, Parish bulletin boards; the Parish’s weekly bulletin; the Parish’s website; print and electronic media; Parish marketing, public relations and communications materials and/or presentations; and such other uses as may not be contemplated herein, without further notice or compensation as follows:
Please select only one.
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Replies to above B or C:
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I further understand that by entering into this informed consent and release, and by granting permission as stated herein, I hereby release the Parish, the Diocese of Cleveland, and their respective officers, directors, agents and/or employees from and against any and all liability, loss, damage, costs, claims, and/or causes of action arising out of or related to the above items to which I have consented. I further understand that the Parish and its respective officers, directors, agents and/or employees have no control over use of photographs, videotapes, audiotapes, or other records made by others and/or outside the scope of this consent and release. Finally, in signing below I acknowledge that all recordings, audiotape, videotape, photographic proofs, photographic negatives, positives, and prints shall constitute the property of the Parish.
Permission Options:
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Medical Emergency Form
Purpose - To enable parents and guardians to authorize the provision of emergency treatment for children who become ill or injured while attending the rehearsals and the Children’s Christmas Nativity Program when parents or guardians cannot be reached.
Parent's Name:
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Phone: -- ext
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If I cannot be contacted and it is advisable to send my child home due to minor illness or injury, my child can be released to the following:
Name:
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Relationship:
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Phone: -- ext
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Parent's Signature
Electronic Signature of Parent(s) or Legal Guardian(s):
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Spam Capture
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