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Vocations – Events
Visit to Kenrick-Glennon Seminary
Love's Reply Retreat
Quo Vadis Permission Form
Kenrick-Glennon Days 2024
Welcome
Archbishop
Donate
Vocations – Events
Visit to Kenrick-Glennon Seminary
Love's Reply Retreat
Quo Vadis Permission Form
Kenrick-Glennon Days 2024
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Quo Vadis Permission Form
Vocations – Events
Quo Vadis Permission Form
Quo Vadis Permission & Liability Waiver
General Information
Retreatant's First and Last Name
(Required)
Date of Birth
(Required)
Parent/Guardian Name
(Required)
Parent/Guardian Phone
(Required)
Parent/Guardian Email Address
(Required)
Emergency Contact Name and Phone
(Required)
Health Information
Is this participant in general good health and able to participate in common activities (if not, please explain).
(Required)
Is your son presently taking any medications?
(Required)
yes
no
If yes, please list them and provide directions for frequency and dosage.
Will your son be bringing any over the counter medications with him?
(Required)
yes
no
If so, please list them:
Please list any special dietary needs or allergies:
Health Insurance Company
(Required)
Health Insurance Policy and/or Group #
(Required)
Name of Primary Health Insurance Holder
(Required)
Permissions and Liability
Participants will spend most of their time at Savior Pastoral Center under the supervision of Fr. Dan Morris, with help from other priests and seminarians. Activities may include but are not limited to: Adoration, Mass, sports and games, prayer, meals, and discussion. Saturday morning, the retreatants will be carpooling to the Cathedral of St. Peter in Kansas City, KS for a tour, Mass, and lunch before returning to Savior Pastoral Center.
Permission of Parent/Guardian (check all that apply):
(Required)
I request that my son be allowed to participate in the event described above, and hereby give my permission for such participation.
I give my permission to the Archdiocese of Kansas City in Kansas to take photographs and video of my child during the event for possible future promotional use.
Consent for disclosure to individual involved in the care and treatment of Participant
For the duration of the event, I grant to the Archdiocese of Kansas City in Kansas and its agents the following powers, to be used for the benefit of and on behalf of Participant (check all that apply):
(Required)
to receive any and all individually identifiable health information about the past, present, and future medical condition of Participant, including, but not limited to, information necessary to the care and treatment of Participant and any illness or injury Participant may have sustained;
to authorize medical care for Participant, including, but not limited to, any and all treatment, examination, diagnosis or outpatient medical care rendered under the general or special supervision of and on the advice of any physician or surgeon licensed to practice medicine by the applicable licensing body in the state in which physician or surgeon practices.
I consent to the logistics and conditions described above, including the method of transportation.
I understand that there is risk of injury involved in any retreat activity and that, as the parent/guardian, I may be responsible for any liability which results from the conduct of Participant at or during the event. I hereby release the Archdiocese of Kansas City in Kansas, and its officers, agents, employees and volunteers, from any liability arising from claims of any kind or nature whatsoever in connection with Participant’s participation in the event.
Parent's Electronic Signature
Today's Date
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