I understand that the Religious Education program does not assume responsibility for payment of a physician. If our physician cannot be reached, a school official may choose a physician.

Authorization of Consent for Treatment of a Minor
In the event of a serious emergency and none of the persons listed on this form can be contacted, I authorize Religious Education officials to call my family physician, or if the situation demands, to transfer my child to the nearest hospital for emergency care. I consent for any X-ray examination, anesthetic, medical or surgical diagnosis or treatment which is deemed advisable by and rendered under the general or special supervision of any physician and/or surgeon licensed under the provisions of the Medicine Practice Act, whether such diagnosis or treatment is rendered at the physician's office or at a certified hospital. 
I hereby agree to bear all costs incurred as result to the foregoing.

Photo/Video Release
By signing below, I hereby acknowledge and agree and grant permission for St. Rose of Lima, Roseville Parish, to use and/or publish any and all videos, photos, media, audio or other images of my minor child, to the extent those materials are captured during Faith Formation programs, posting on the Parish websites or social media, or inclusion in bulletins of other written Parish publications.