POLICY FOR ADMINISTRATION OF MEDICATIONS BY DIOCESE OF VICTORIA DESIGNEES

This form specifically pertains to “over the counter” medications and prescription medications provided by the legal guardian for participants in parish/diocesan sponsored activities.

A. Medications prescribed by a licensed healthcare provider and dispensed by a registered pharmacist may be administered for the duration of the parish/diocesan activity by authorized diocesan designee and only with this signed Medication Request Form.
B. “Over the Counter” medication provided by the parent may be administered for the duration of the parish/diocesan activity by authorized parish/diocesan designee only with this signed, complete Medication Request Form.
C. A prescribed medication may be administered for as long as the licensed healthcare provider requests based on the directions provided on the prescription. No medication shall be administered after its expiration date has passed.
D. All prescribed and “over the counter” medication must be in the original container and properly labeled. E.

Medication Request Form must be signed by the parent or legal guardian.

Please complete this form only if your child will need medication administered during the event. Children MAY NOT keep their own medication with them, except for an epinephrine (epi-) pen, insulin, and/or an inhaler.

I consent for this medication to be administered by a parish/diocesan/school employee or volunteer of the Diocese of Victoria. I further release the Diocese of Victoria and its personnel from any liability resulting from any adverse effect that this medication may cause when dispensed at parish/diocesan activities. I understand that if I do not agree to this policy, “over the counter” medications and prescription medications provided by the legal guardian for participants will not be administered at the above mentioned event.

YOUTH PERMISSION FORM/MEDICAL RELEASE

I request and give my consent for my son/daughter, to participate in all church/school sponsored activities from July 16th 2023 through July 19th 2023 sponsored by Quo Vadis Camp and/or by the Diocese of Victoria. I understand that my son/daughter will be under the supervision of diocesan and/or parish/school personnel. I give my permission to the personnel in charge of the activity to search my child’s belongings, bag, backpack, or other container as deemed necessary. As parent or legal guardian I agree to defend, indemnify and hold harmless the Diocese of Victoria and Quo Vadis Camp, its clergy, officers, agents, employees and volunteers from any claims, costs or expenses for property damages, personal injuries, illness, disease (e.g. COVID-19), and/or other damages arising out of my son/daughter's participation in the above mentioned activity or during the transportation to and from the event. I grant permission for non-prescriptive medication (e.g. tylenol, throat lozenges, cough syrup, pepto-bismol, etc.) and routine nonsurgical medical care to be given to my son/daughter if deemed advisable by the supervising diocesan and/or parish personnel. In case of an emergency, I also grant permission to transport my child to the nearest hospital for emergency medical treatment and for an authorized adult sponsor to sign for treatment if I cannot be located.

Physician Information

Insurance Information

Emergency Contacts

Video/Photo/Media/Audio Release

I hereby grant Quo Vadis Camp (School/Parish/Diocesan Entity) the right to make, use, and/or publish any and all videos, photos, media, audio, or other images of my minor child in which they may be included, now existing or hereafter made, in any case, with or without identifying (him/her) for editorial, advertising, news, social media, or any other purpose and in any manner and medium. I hereby release and agree to fully and unconditionally defend, indemnify, and hold harmless Quo Vadis Camp (School/Parish/Diocesan Entity) and the Diocese of Victoria, its clergy, officers, Agents of the Church, employees and volunteers from any claims, costs or expenses for property damages, personal injuries, or other damages that may arise out of my minor child’s participation.

I understand that all communication with my minor child will be directly related to an approved School/Parish/Diocesan Entity activity.
In addition, I understand there will be no financial or other remuneration for recording my minor child in photos, videos, audio, or other images for initial or subsequent use, transmission, or playback.

I hereby give permission for my minor child to be in video/photos/media/audio/other images.