Diocese of Ogdensburg

The Roman Catholic Church in Northern New York

Medical & Parental Permission Form
Participant Information
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Fill out address below only if different than participant. Please include phone numbers.
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Fill out address below only if different than the participant. Please include phone numbers.
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Emergency Contact
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Medical Information
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If necessary, describe the nature and severity of any physical and/or psychological ailment, illness, propensity, weakness, limitation, handicap, disability or condition to which your child is subject and/or which the staff should be aware, and what, if any, action or protection is required on account thereof. Please submit this notification in writing and attach it to this form.
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Please list all medications and dosages (prescription and non-prescription) being sent with your child. All medication will be collected at registration and dispensed by the event’s health coordinator.
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By typing your full name in the Full Name of Parent or Guardian field above you certify that everything in this form is true and that you understand what is being asked of you.


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