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Home
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Synod 2021-2024
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Sacraments
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Preschool
Early Childhood Connections
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About Us
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ECC 1 and 2 year-olds
ECC Pre-K 3-5 year-olds
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Registration
T-Shirt Order Form
Parish Life
News & Events
Bulletins
Ministries
First Friday Adoration
Health Ministry
Hospital Ministry
Ministry Scheduler Pro
Parish Nursery
Pray the Rosary
Safe Environment
Vocations Candle
Service
Christian Action
Time & Talent
Spiritual Life
Spiritual Life
Spiritual Direction
Advent Evening of Prayer & Reflection
Christian Meditation
Couples for Christ
Days of Prayer
Faith Sharing Small Groups
Grief Support
Jubilee Year of Hope
Las Posadas
Parish Missions
Prayer Heartline
Retreats
Walking With Purpose
Women's Book Study
Becoming Catholic/RCIA
Groups
Online Groups
Finance Council
Groups who meet at St. Bernadette
Knights of Columbus
Men of the Cross
Pastoral Council
Scouts - BSA
Vision Gifts
Women at the Well
Young Adults
News & Events
Evangelization
St. Gabriel's Herald
Consecration Prayer
Fr. Marius Zadinski Scholarship for Seniors
Renovations
Playground Drainage and Improvements
Drainage Project Front of Education Wing - completed
Drainage Project Church Courtyard - Completed
Church Restroom Renovations
PLC Restroom Renovations
Education Wing Rebuild
PLC Chairs
Capital Campaign
News/Events
Deacons' Reception 2025
USCCB Statement on Protected Places and Immigration
News, Events & More
Calendar
Daily Readings & More
...in a Year Podcasts
World Day of Prayer
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Release and Liability Under 21
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Circle of Grace
Parental/Guardian Consent Form & Liability Waiver
The maximum number of form submissions has been reached. This form is currently not available.
Participant's Name
REQUIRED
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Date of Birth
REQUIRED
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Home Address
REQUIRED
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City/Zip Code
REQUIRED
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Parent(s)/Guardians(s):
REQUIRED
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Please enter valid data.
Home Phone
REQUIRED
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Alternate Phone
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Parish or Catholic School Name
REQUIRED
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Grade
REQUIRED
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Age
REQUIRED
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Sex
REQUIRED
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Email Address
REQUIRED
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T-Shirt Size
None
Small
Medium
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2XL
3XL
4XL
Please specify the Event/Date & Time/Location for this waiver
REQUIRED
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Please enter valid data.
I (as the parents/guardian) grant permission for my child to participate in the event listed above at the time and location listed above.
In consideration of my child's participation in this event, I agree on behalf of myself, my child named herin, and our heirs, successors, and assigns to indemnify, hold harmless and defend the Archdiocese of Galveston-Houston, the sponsoring parish, its pastor, youth ministry leader, principal, other agents, employees or other representatives associated with the event from any and all injuries, losses or claims arising out of my child's paricipation in the event.
In clicking
I Agree
on this form I certify that all information contained herein is true and accurate to the best of my knowledge.
I Agree
Please select this field.
YOUTH PATICIPANT:
In clicking I Agree below I agree to abide by any/all policies and rules established for this event/activity (see Code of Conduct). Should I not be able to maintain the guidelines and expecations of the adults and my peers, I understand that there will be consequences for my actions, including being removed from the activity and being sent home at my parent's expense.
I Agree
Please select this field.
Video/Photography Consent:
As parent/guardian, I understand that promotional pictures and videos (individual and group) will be taken during this event. I give permission for my son's/daughter's picture to be used for promotional materials (newsletter, web page, calendars, power point, video etc.) in highlighting the event.
I Agree (Video/Photography)
Please select this field.
Medical Matters:
I hereby warrant to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. Of the following statements pertaining to medical matters, Agree to only those in accordance with your wishes.
Emergency Medical Treatment:
In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor and I understand that all financial obligations are my responsibility.
In the event of an emergency and you are unable to reach me, contact:
Name & Relationship
REQUIRED
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Phone
REQUIRED
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Family Doctor
REQUIRED
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Phone
REQUIRED
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Please enter valid data.
Medications:
My child will bring all such medications, well labeled, that are necessary. Names of medications and concise directions for seeing that the child takes such medications, including dosage and frequency are as follows:
Medications & Dosage:
REQUIRED
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Administer:
REQUIRED
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Please enter valid data.
I hereby DO NOT GRANT PERMISSION for medication of any type, whether prescription or nonprescription, to be administered by my child unless the situation is life threatening and emergency treatment is required.
Do Not Grant Permission
I hereby GRANT PERMISSION for nonprescription medication (such as Tylenol, throat lozenges, cough syrup) to be given to my child, if deemed advisable. I understand that Aspirin will not be given to my son/daughter.
Grant Permission
Medical Conditions Information:
(Archdiocesan personnel will take reasonable care to see that the following information will be held in confidence.)
My son/daughter has:
Has had an episode of the following or has been diagnosed:
Seizures
Asthma
Diabetic
Allergic reactions to the following (foods, dyes, latex etc.)
Please enter valid data.
Has had a medical surgery within the last six months?
None
Yes
No
Still under doctor's care?
None
Yes
No
Has a medically prescribed diet?
Please enter valid data.
The following physical limitations:
Please enter valid data.
Immunizations current and up to date:
None
Yes
No
Date of last tetanus/diphtheria immunization
Please enter valid data.
You should also be aware of these special medical conditions of my child (e.g. depression, anxiety, etc)
Please enter valid data.
Insurance Information
None
Yes, I do carry medical insurance at this time
No, I do not carry medical insurance at this time
Insurance Carrier
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Name of Insured
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Insurance Policy Number
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Father's Name
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Day Phone
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Mother's Name
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Day Phone
Please enter valid data.
In the event it comes to the attention of the chaperones associated with the activity that my child becomes ill with repeated symptoms such as headache, vomiting, sore throat, fever, diarrhea, I want to be called immediately. If this will be a long distance call, I want to be called collect (with phone charges reversed to myself). I fully understand the foregoing statements and I Agree to this Parental/Guardian Medical Consent Waiver knowingly, freely, and willingly.
I Agree
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