Quo Vadis Permission Form

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.

Quo Vadis Permission & Liability Waiver

General Information

Health Information

Permissions and Liability

Consent for disclosure to individual involved in the care and treatment of Participant

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