March for Life Permission Form 2025 Please fill out one form per student attending. Every person attending the March for Life MUST fill out this form (chaperones and students)ARCHDIOCESE OF CINCINNATI PERMISSION, RELEASE AND MEDICAL POWER OF ATTORNEY(Required) I have read and agree to the terms and conditions stated below1. I, the undersigned, do hereby 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, damages, costs and expenses, including attorney fees, arising out of any injury, illness, infectious and/or communicable disease, or death caused by the negligence of Parish and School, the Archbishop, the Archdiocese, any parish or school within the Archdiocese, or any of their agents, representatives, volunteers, or employees) incurred by me or my child while participating in or traveling to the March for Life 2025 in Washington, DC (further described on reverse). I further agree not to bring or prosecute or allow to be brought or prosecuted (including, but not limited to, prosecution through subrogation) in my name, or on behalf of my child, any claims, lawsuits, or actions against the Archbishop, the Archdiocese, all parishes and schools within the Archdiocese, or their agents, representatives, volunteers, and employees. 2. I understand that my (or my child’s) participation is purely voluntary and is a privilege and not a right, and that I (or my child and I on behalf of my child) elect to participate in spite of the risks of injury, illness, infectious and/or communicable disease (such as MRSA, influenza, or COVID-19), and death. I agree that if my Child has underlying heath concerns which may place him/her at greater risk of contracting COVID-19 or that would possibly increase the severity of illness if COVID-19 is contracted, then my Child and I will consult with a health care professional before participating in the Activity 3. I agree (or agree to instruct my child) to cooperate with the Archbishop or his agents in charge of this activity. Should it be necessary for me or my child to return home, whether through disciplinary, medical or other reasons as deemed at the sole discretion of the representatives of the Archdiocese, including symptoms of contact with COVID-19, I agree to assume any and all related transportation expenses to avoid sending me or my child home on the bus. 4. I authorize the agents of the Archdiocese and/or the Parish and/or School who are acting as leaders of the Activity to seek medical treatment for my Child in the event of any injury, illness, or medical emergency during the Activity or related travel. I understand that the agents of Parish and School and/or the Archdiocese will make a reasonable attempt to contact me as soon as possible in the event of a medical emergency involving my Child.5. The Parish and School and/or the Archdiocese may use my Child’s portrait or photograph for promotional purposes, website, and office functions.(Required) I agree I disagree PERMISSION, RELEASE, AND MEDICAL POWER OF ATTORNEY (continued)(Required) I have read and agree to the terms and conditions stated below6. This Permission, Release, and Authorization is intended to be as broad and inclusive as permitted by the law of the State of Ohio, and if any portion hereof is declared invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This Permission, Release, and Authorization shall be construed in accordance with the laws of the State of Ohio, excluding, and irrespective of, any choice of law principles to the contrary. 7. Parish and School, the Archdiocese, the Archbishop and their agents, employees, and volunteers shall have no liability whatsoever in the event the Activity is cancelled due, in whole or in part, to any present or future pandemic, epidemic, widespread disease or illness, public health concern, or circumstances arising therefrom, or from actions taken by any governmental or municipal authority to prevent, avoid, or mitigate the impacts thereof.REFUND POLICY(Required) I have read and agree to the terms and conditions stated below In the event that I,or my child cannot attend for any reason, there will be no refund of payments made. In the event the Archdiocese cancels the event due to forces beyond its control (i.e., inclement weather or pandemic), there may be a full or only partial refund based upon what funds the Archdiocese is able to recover from paid expenses.I have carefully read and understand and accept the terms and conditions stated herein and I acknowledge and agree that this Permission, Release, and Authorization to Seek Medical Treatment shall be effective and binding upon me, my Child, and our personal representatives, estates, assigns, heirs, and next of kin. I have signed below of my own free will.(Required) I agreeParticipant Name First Last Birthdate MM slash DD slash YYYY GenderMaleFemaleParish/School Address Street Address City State / Province / Region ZIP / Postal Code If the participant to whom this form belongs is a STUDENT this Signature must be from a PARENT or LEGAL GUARDIAN. If the participant to whom this form belongs is an ADULT CHAPERONE you must sign it yourself: (FIRST NAME, MIDDLE NAME, LAST NAME) TODAYS DATE: MM/DD/YYYY PHONE NUMBER Medical InformationParticipants Name First Last Participant Brithdate MM slash DD slash YYYY Allergies (especially foods): Special Dietary Concerns: Current Medications: Chronic Conditions (i.e. epilepsy, diabetes): Family Physician: Physician's Name Physician's Phone (XXX-XXX-XXXX) Emergency Contact: Emergency Contact Name (First, Last) Emergency Contact Phone (XXX-XXX-XXXX)
