IMPORTANT
In Case Of Emergency, and in the event that I am not coherent or conscious, I hereby grant Nativity of our Lord Parish Priests permission to act on my behalf in seeking emergency medical treatment for myself in the event that such treatment is deemed necessary. I hereby give permission to emergency and hospital personnel to release information on my condition to Nativity of our Lord Parish personnel.

I hereby give my permission to those administering medical treatment to do so.

I further absolve and release Nativity of Our Lord Parish, its Pastor, employees, and volunteers, as well as the Diocese of Pensacola-Tallahassee and its employees, and the Catholic Student Union, from any liability whatsoever when acting on my behalf in regard to medical treatment, and in any other respect deemed necessary should I become incapacitated.

The Diocese of Pensacola-Tallahassee and its parishes and its employees will not be held liable in the event of any injuries or death.

By selecting "I Agree," I am signing my name and agreeing with what is stated above.