Records Release for High School Admission Purposes STUDENT NAME HOME ADDRESS CITY, STATE, ZIP CODE St. John’s Episcopal School has my permission to release sixth through eighth grade records for the student listed above to the following schools for high school application purposes. Bishop Dunne High School Jesuit College Preparatory School Bishop Lynch High School Lakehill Preparatory School Cistercian Preparatory School Parish Episcopal School Episcopal School of Dallas St. Mark’s School of Texas Greenhill School Ursuline Academy of Dallas The Hockaday School ADDITIONAL SCHOOL NAMES PARENT NAME PARENT SIGNATURE DATE Records Release for Accreditation Purposes STUDENT NAME HOME ADDRESS HOME CITY, STATE, ZIP CODE HIGH SCHOOL ATTENDED FOR FRESHMAN YEAR HIGH SCHOOL CITY, STATE The school listed above may release the freshman year scholastic average and class rank for my child for use by St. John’s Episcopal School to report statistical data to its accrediting organizations, the Independent Schools Association of the Southwest and the Southwestern Association of Episcopal Schools. I understand that all information will be handled in a confidential manner. I hereby certify that I am the parent or legal guardian of: STUDENT NAME PARENT SIGNATURE DATE PARENT PERMISION AND RELEASE FOR CAMPUS VISIT DAY Ursuline Academy of Dallas/Jesuit College Preparatory STUDENT’S NAME: SCHOOL: has my permission in the Ursuline/Jesuit (student’s name) Campus Visit Day Program. I understand that my child will be taken on a bus from school to Ursuline/Jesuit for a morning program. I agree to hold Ursuline/Jesuit Schools and personnel blameless from all liability, loss, damage or injury to him/her during the visit day. Photo Release I understand that photos may be taken of my child during the course of the School day, and I hereby consent for utilization of such photos for admission purposes. ______ YES ______ NO In the event of an accident, permission is hereby granted to proceed with any appropriate medical or first aid treatment for the above-named participant. In the event of serious illness, should there be a need for a major surgery or medical procedure, I understand that every attempt will be made to contact the individual listed below in the most expeditious manner possible. In the event they cannot be reached, I understand that it may be necessary to provide acute medical care, surgical procedures, and/or anesthesia without specific consent. In consideration for the named participant’s participation in the activity, I agree to assume responsibility for injuries caused by the Institution’s and or its Representatives negligence. Signature of Parent or Guardian Date Person to be contacted in case of any emergency: Name: Phone: PARENTAL PERMISSION AND RELEASE _____________________________________ is my child, and is now under my control and in my custody. I desire to send said child to visit Bishop Lynch High School with his/her eighth grade class on ________________________. In consideration of said child being permitted to make this trip and take part in the activities of the visit, I hereby release and discharge, and agree to indemnify and hold harmless the Diocese of Dallas and Bishop Lynch High School, and their respective school board members, teachers, employees and agents, from any and all liability and responsibility in connection with such visit, and for any act or omission, including negligence (but not including gross negligence or willful or wanton acts), resulting in death, damage, or injury to the person or property of such child. AUTHORIZATION AND CONSENT TO PROVIDE EMERGENCY MEDICAL CARE I authorize Bishop Lynch High School and its representatives to consent to and obtain emergency medical treatment of my child in case of any illness or injury in connection with this school visit, such treatments to be administered by such physicians, other medical personnel, hospitals, and/or clinics as may be selected by Bishop Lynch High School or its representatives. PHOTOGRAPHY CONSENT AND RELEASE WAIVER I grant Bishop Lynch High School the right to take photographs of my child with the above-identified event. I authorize BLHS its assigns and transferees to copyright, use and publish the same in print and/or electronically. I understand that these photographs may be used in such purposes as publicity, illustration, advertising and Web content. _______________________________ ____________________ Signature of parent or guardian Date .