Missionary Info

Please select one option, even if there is only one available.

Parent/Guardian Info

Parent Consent To Participate and Indemnity Agreement

In consideration for my child/ward’s participation, I agree to reimburse and indemnify the parish or Archdiocese of Milwaukee for all reasonable legal and court fees incurred by the parish or Archdiocese in defending a lawsuit that I or my child/ward may bring against the parish or Archdiocese of Milwaukee which relates to Love Begins Here Milwaukee if the parish or Archdiocese is found not legally liable by the courts and prevails in the lawsuit. If the parish or Archdiocese is found legally liable for injuries sustained by child/ward, this paragraph will not apply. 

I certify that I have an understanding of this agreement and any risks and hazards associated with participation in Love Begins Here Milwaukee. I further understand that I had the opportunity to fully discuss this agreement with a representative of the parish or Archdiocese to clarify any concerns or questions about the activity or this agreement that I may have had. 

I have read the information above and give consent for my child to participate in all aspects of this field trip. 

By entering my full name, I attest that this constitutes my legal electronic signature on this form.

Photo/Video Release

I hereby consent that any still or electronic image and/or video recording, in which my child may appear, may be used by the Archdiocese of Milwaukee. I understand that these materials are being used for promotion of Love Begins Here Milwaukee and/or the Archdiocese of Milwaukee. The images and/or recordings may be used to support participation, fundraising, evangelization and other communication efforts.

I release the staff and volunteers and I understand and agree that the use of my picture is not an invasion of privacy. Neither I, nor anyone claiming to be speaking on my behalf, will later object to the Archdiocese's use of these images and/or recordings.

By entering my full name, I attest that this constitutes my legal electronic signature on this form.

High Risk Notification & Consent

Love Begins Here offers activities that are considered high-risk to participants. Love Begins Here staff are not qualified to provide instruction or supervision for these high-risk activities; however, the venue has trained staff who will be in charge of these activities.

Listed below are high-risk activities that may be available to your child. Please indicate your approval or disapproval next to each activity. Missionaries will be given a low-risk activity in which to participate if the parent does not want the child to participate in a high-risk activity. Please communicate with the Love Begins Here staff or your parish group leader if you have concerns or questions regarding your child's participation in a particular activity.

By entering my full name below, I attest that this constitutes my legal electronic signature on this form.

Medical Information & Release

Emergency Medical Treatment & Contact 

In the event of an emergency, I give permission to transport my child to a hospital for emergency medical treatment. I wish to be advised prior to any further treatment by the hospital or doctor.

If you are unable to reach a parent/guardian at the above numbers, contact:

Physician & Insurance Information

Other Medical Information & Medications

List all medications, prescription and over-the-counter, that the student currently takes at home and during the school day. Include all as-needed and emergency medications. Medications not authorized for self-carry must be in original container and given to the designated supervisor.

Note: for all prescription medications, a Medical Provider Consent form must be filled out by your medical provider and on file with the Love Begins Here staff prior to your week. Find the electronic form here.

In the event that the child becomes ill with symptoms such as headache, vomiting, sore throat, fever, or diarrhea, do you grant permission for Love Begins Here staff to give your child non-prescription medication, such as acetaminophen, throat lozenges, cough syrup, or antacid?

Parent Consent for Medical Treatment and Administration of Medication

I hereby warrant that to the best of my knowledge, my child is in good health and I assume all responsibility for the health of my child. I give the school/parish permission for emergency and other medical treatment, including the administration of the above prescription and nonprescription medication(s). 

By entering my full name, I attest that this constitutes my legal electronic signature on this form.


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