Seraphim Youth Choir Registration

Authorization of Consent to Treat Minor:
I am the Parent/ Guardian/Conservator and as such do hereby authorize St. Rita Catholic Community, its leaders, employees, contractors and volunteers as agent(s) for the undersigned to consent to any x-ray examination, anesthetic, medical, dental or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered under the general or specific supervision of any physician or surgeon licensed under the laws of the jurisdiction where such diagnosis or treatment may be given, whether such diagnosis or treatment is rendered at the office of said physician, at a hospital, or at any other location. In consideration of acceptance of this authorization, but without any time limitation and without any future right of revocation, I hereby release, defend and hold harmless the Parish and the Diocese of Dallas, their offices, directors, employees, youth ministry leaders, volunteers, and contractors from all claims, liabilities and loss in any way arising out of or in connection with or relating to such treatment and treatment decisions.

Media Consent:
I hereby grant permission to St. Rita Catholic Community to allow my above-named child to be photographed and/or interviewed. It is my understanding that these photographs and/or interviews or portions thereof will be used for public view. I agree to participate in this project without financial remuneration, and I understand that this releases St. Rita Catholic Community and the Diocese of Dallas from any future claims as well as from any liability arising from the use of said photographs and/or interviews.