Culture of Life Conference

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, 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.