Authorization, Consent for Medical Treatment, and Release of Liability

I hereby give permission for my child to attend and participate in a youth event sponsored by the Episcopal Diocese of Texas.

I confirm that my child is healthy and capable of participating in this event.  I also confirm that my child is covered by medical insurance, or, if medical insurance is not available, I agree that I will be personally responsible for the costs of any medical treatment deemed necessary. 

I hereby release, relieve, indemnify, and hold harmless the Episcopal Diocese of Texas and its bishops, clergy, event coordinators, youth leaders, employees, representatives, and agents, as well as Texas A&M University, Texas A&M System, the Texas A&M Board of Regents, and the State of Texas from any and all liability for any injury, illness, or property damage associated with my child’s participation in this activity or travel associated with this event. 

In the event that my child should require medical treatment and I cannot be contacted immediately, or if contacting me is not feasible because of an emergency, I hereby give my consent to such treatment.

I understand that photos or videos of my child and others may be taken during the event, and I consent to the use of my child’s photo or likeness by the Diocese of Texas or Texas A&M University in promotional materials.

I acknowledge and confirm that the information listed on my child’s application is true and accurate.

Release of Liability

Release of Liability

This field will be accepted as serving as a signature for the electronic document or record

Emergency Contact Information:

Name of individual(s) participating in Event:

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