Faith Formation Registration – Page 5 of 6

Note: This form is optional. By signing this form, you are agreeing that the people listed below can transfer the minor listed below to and from school. If you do not wish to grant anyone this permission, simply select the “Opt Out” checkbox rather than filling out the form. You still must hit the submit button to continue the registration process.

Parent Consent to Release Minor to Third Party

Hidden

Diocesan Entity(Required)

Hidden

Date of Event

Opt Out?

Please check the box below if you would like to opt out from completing this optional form. If you do opt out, please still click the submit button to submit the form and continue with the registration process.

Opt Out

Yes

Parent / Guardian Name(s)(Required)

First Last

Minor Name(Required)

First Last

If registering multiple people, separate names by comma

Release Form

Parent / Guardian #1 Name(Required)

First Last

Parent / Guardian #2 Name

First Last

Minor Name(Required)

First Last

If registering multiple people, separate names by comma

I, the undersigned parent/guardian of the minor listed above, hereby give permission for my minor to be released to the following adult (listed below), upon the provision of picture identification, on the date specified above, at such time or under such circumstances as are identified below.

Adult's Name(Required)

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Time, Event, Circumstances for release form(Required)

I understand that the parish/school may or may not know this third party and makes no representation regarding the individual’s character, criminal history, driving record, insurance, or fitness to supervise children. Upon the release of my minor to the above identified third party, the parish/school has no further responsibility for my minor’s care or well being whatsoever.

I hereby release school/parish/program, the Bishop, individually and as a corporation sole, and all agents, employees and volunteers of said parish/school/program (hereinafter collectively known as “church”) from any and all liability, including that arising from the negligence of the Church that may arise from acting in accord with the terms of this Consent. I hereby agree to hold harmless and indemnify Church from any claim that may be made against it arising from this Consent.

Parent / Guardian Signature #1(Required)

Parent / Guardian Signature #2(Required)

Name

This field is for validation purposes and should be left unchanged.