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Home
About Us
Mission and Philosophy
Contact Us
Hours of Operation
Faculty and Staff
Employment
Holy Family Academy Virtual Tour
Press Releases
Admissions
Attending Holy Family Academy
Post-Graduation
Tuition for 2022-2023
Giving
Parent Play Fundraiser
The St. Catherine of Siena Library
2023 Spring Benefit Donation
Make a Gift
Our Generous Sponsors
Academics
Why Classical Curriculum?
Thesis
The Honors Program
College Guidance
Science Fair
Articles Related to the HFA Education
Student Life
Alumni Mentoring Program
Extracurricular Actvitiies
Student Service Leadership Council Round Table
Student Clubs
Performance Groups
Choir
Drama Program
Student Classes by Subject
Parent Resources
Calendar of Events
FACTS
School Year Calendar (downloadable)
Handbook
Dress Code/Uniforms
Course Texts & Supplies
Alumni
Past Alumni Events
Photo Albums
HFA Video Archives
Transcript Requests
Parental Authorization Form
Parent Resources
Calendar of Events
FACTS
School Year Calendar (downloadable)
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Course Texts & Supplies
Parental Authorization Form 2019-2020
The maximum number of form submissions has been reached. This form is currently not available.
Student Information
First Name
REQUIRED
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Last Name
REQUIRED
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Grade
REQUIRED
(Select One)
7
8
9
10
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12
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Parent/Guardian Name:
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OF
Street Address
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City
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State
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Zip
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A. AUTHORIZATION TO CONSENT TO MEDICAL TREATMENT:
In the event I cannot be contacted to give my consent, I hereby authorize Holy Family Academy, its officers, agents, and employees in my place for:
1. The administration of any treatment deemed advisable by a licensed physician or dentist.
2. The transfer of the minor to any hospital or clinic reasonable accessible.
IF PRACTICABLE UNDER THE CIRCUMSTANCES, I AUTHORIZE HOLY FAMILY ACADEMY TO CONTACT MY CHILD'S PHYSICIAN.
Physician Name:
REQUIRED
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Street Address
REQUIRED
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City
REQUIRED
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State
REQUIRED
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
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Zip
REQUIRED
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Please enter a zip code.
Phone Number
REQUIRED
Maximum 20 characters
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I understand this authorization is given to provide authority and power on the part of Holy Family Academy, its officers, agents, and employees to give specific consent to any examination, diagnosis, treatment, or hospital care which, in the judgment of a licensed physician or dentist, is deemed advisable.
B. AUTHORIZATION TO PARTICIPATE IN ATHLETICS AND OTHER ACTIVITIES:
I hereby give my consent for the above-named student to participate in the athletic programs and other programs of Holy Family Academy.
C. AUTHORIZATION TO PARTICIPATE ON FIELD TRIPS
I hereby give my consent for the above-named student to attend and participate in field trips associated with Holy Family Academy. I give permission for the above-named student to travel by van/car with a parent or HFA faculty member.
I understand that Holy Family Academy does not assume any responsibility in case any accident or injury occurs. In consideration for the above-named student being
permitted
to make such trips, take part in such activities, and receive the agreed-to medical treatment and /or
medication
, I hereby
agree
to waive all claims release, indemnify, defend and hold harmless Holy Family Academy, its Trustees, Directors, Heads of School,
Faculty
, agents, employees and invitees, together with all persons, including parents of students of Holy Family Academy assisting with any phase of such trips and activities (excluding paid certified carriers not affiliated with Holy Family Academy), from any and all claims, suits, losses, damages, causes of action or other liabilities,
including
all expenses of
litigation
and/or settlement which may arise in connection with such trips and activities. I hereby also agree to waive all claims, release, indemnify, defend and hold harmless all of
said
parties from any and all liability by reason of any accident or injury suffered by the above-named student while on such trips or participating in such activities. I hereby further expressly agree that such indemnity will apply whether the claims suits, losses, damages, causes of action or other liabilities arise in whole or in part from any form of negligence of said parties.
I understand that Holy Family Academy does not assume any responsibility in case any accident or injury occurs. In consideration for the above-named student being permitted to make such trips, take part in such activities, and receive the agreed-to medical treatment and /or medication , I hereby agree to waive all claims release, indemnify, defend and hold harmless Holy Family Academy, its Trustees, Directors, Heads of School, Faculty , agents, employees and invitees, together with all persons, including parents of students of Holy Family Academy assisting with any phase of such trips and activities (excluding paid certified carriers not affiliated with Holy Family Academy), from any and all claims, suits, losses, damages, causes of action or other liabilities, including all expenses of litigation and/or settlement which may arise in connection with such trips and activities. I hereby also agree to waive all claims, release, indemnify, defend and hold harmless all of said parties from any and all liability by reason of any accident or injury suffered by the above-named student while on such trips or participating in such activities. I hereby further expressly agree that such indemnity will apply whether the claims suits, losses, damages, causes of action or other liabilities
arise
in whole or in part from any form of
negligence
of said parties.
I AGREE to the above statements
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By typing your name in the space below, you are acknowledging that the above information is correct.
Parent/Guardian Signature
REQUIRED
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Relation to student
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Date
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Email
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