Please fill out the form below to register for our Sunday Faith Formation classes. If you have any questions please contact Kerry Schlimgen at kschlimgen@saintsimon.org or 317-826-6000 x 180.
I understand that in the case of a serious medical emergency, unless the injury/illness appears to be immediately life-threatening, the staff will make reasonable attempts to contact me/us as specified above before authorizing medical treatment. If I/we are not available to give consent, I/we hereby authorize the staff of (school, parish, or archdiocesan program) to act on my/our behalf, to call 911 emergency services, transport by ambulance, hospitalize; secure proper treatment; authorize injections, anesthesia, x-ray, surgery or other treatment for my child as deemed necessary by qualified medical personnel. I also understand that the medical information provided will be shared only on a medical “need-to-know” basis among staff and with treating medical personnel.
Notice is hereby given to qualified medical personnel that this authorization is currently in effect, and such personnel are directed to act upon this authorization without delay. I/we agree to assume financial responsibility for all expenses incurred in any emergency requiring medical attention.
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