St. John Summer Faith Formation for Children for all students entering grades 1 through 8 in the 2013-2014 school year!

This two-week program takes the place of the weekly Parish School of Religion program at St. John.

When: June 10-14/17-21, 2013 9:00am-12:30pm

Where: St. John Education Center

Cost: $70 per child by May 1st (fees can be paid online this year!)

Please complete this entire form (registration and medical release form) for every child being registered for the Summer Faith Formation for Children. Please be sure to pay the $70 fee prior to May 1st by mailing it or bringing it into the parish office or by clicking on the "Pay Online Today" button on our website. Thanks!

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Archdiocese of Cincinnati Release and Indemnification and Medical Power of Attorney Agreement:

1. I am the lawful parent or guardian of the child being enrolled on this form. I give permission for my child to participate in the activity described herein, and release from all liability and indemnify the Archbishop of Cincinnati (“the Archbishop”), both individually and as trustee for the Archdiocese of Cincinnati and all parishes within the Archdiocese, and their officers, agents, representatives, volunteers, and employees from any and all liability, claims, judgments, cost or expenses, including attorney fees, arising out of any injury or illness incurred by my child while participating in or traveling to or from the activity.

2. I agree to instruct my child to cooperate with the Archbishop or his agents in charge of the activity.

3a. I appoint the Archbishop or his agents who are acting as leaders of the activity as my attorney in fact to act for me in my name and my behalf, in any way that I would act if I were personally present, with respect to the following matters if any injury, illness or medical emergency occurs during the activity or related travel:

(i) To give any and all consents and authorizations to any physicians, dentist, hospital or other persons or institutions pertaining to any emergency medications, medical or dental treatments, diagnostic or surgical procedures or any other emergency actions as our attorney shall deem necessary or appropriate for the best interest of the child.

(ii) I understand that the agents of the Archbishop will make a reasonable attempt to contact me as soon as possible in the event of a medical emergency involving my child.

3b. The powers and authority granted herein may be revoked by me by written notice delivered to the Archbishop or his agents who are then acting or who have previously acted hereunder. Without such written notice, this power of attorney shall not be affected by my disability, incapacity or adjudicated incompetence. This power of attorney shall lapse automatically at the end of above said time period.

4. I agree that the Archbishop or his agents may use my child’s portrait or photograph for promotional purposes and office functions, and hereby release the Archbishop and his agents from any liability resulting from such use.

(Please indicate your understanding and agreement of this information in the field below.)