The adults named below (OTHER than parents) have permission to pick up my child from PSR and are also our emergency contacts:
In case of serious accident or illness, PSR authorities will act according to their best judgment for the welfare of your child. Emergency services in the area may be utilized. I (we) the undersigned parent(s) or legal guardian(s) of the above listed minor(s), do hereby authorize and consent to any emergency medical treatment rendered under the general or special supervision of any member of the medical staff/emergency room staff licensed under provisions of the Medicine Practice Act or a dentist licensed under the provisions of the Dental Practice Act and on the staff of any hospital holding a current license to operate a hospital from the State of California Department of Public Health. It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required but is given to provide authority and power to render care which the aforementioned physician in the exercise of his/her best judgment may deem advisable. It is understood that effort shall be made to contact the undersigned prior to rendering treatment of the patient, but that emergency treatment will not be withheld if the undersigned cannot be reached.
Total tuition for your students is: ${Tuition}
**Registration must be received before child(ren) attend first class. You must register with the parish in order to participate in the PSR program. Parish registration forms are found in our weekly bulletin or on our church website.
*Online payments are processed through PayPal. You may use a credit/debit card or a PayPal account if you have one. Upon submitting this form you will be taken to PayPal to enter your payment information and complete the transaction.
*Cash & Check payments, please drop off in rectory mail slot. Please note: "Attention PSR" on the check