I consent to the participation of my child/ward in this conference and trip. 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 NCYC 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 NCYC 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 program. 

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 NCYC 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.

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 NCYC 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 NCYC 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). 

I also agree that if my child becomes too ill to participate, I will pick them up in Indianapolis.

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