Medical and Media Release Forms

To Who It May Concern,
As a parent/guardian, I do hereby authorize the treatment by a qualified and licensed physician of any condition which, in the opinion of the physician, is deemed necessary and appropriate. This authority is granted only after a reasonable effory has been made to reach me.

Reason for which release is intended: Faith Formation 2020-2021 Year

Health Insurance

I further authorize the person who presents the minor to sign the Acknowledgement of Receipt of Notice Privacy Rights that may be presented by the physician or health care facility. This authorization is completed and signed of my own free will with the sole purpose of authorizing medical treatment deemed necessary and appropriate by the treating physician.


Cathedral of Mary of the Assumption Parish will not photograph, videotape and/or voice record individuals in its programs without consent. This form allows you to give permission for your child/children to be photographed, videotaped and/or voice recorded by parish personnel and/or area news reporters. Photographs, videotape and/or voice recordings, when consented to, will only be used for the purposes you specify below.

I, , hereby give permission for the personnel of the Cathedral of Mary of the Assumption Parish to photograph, videotape and/or voice record my child/children (or allow area news reporters to do the same) for the purposes of:
Parish Programs, PubliclyIn-Parish Purposes Only

This consent must be re-examined and signed each year.