Youth Ministry Registration 2019-20

Question Title

* 1. Please provide the following information:

Participant's name:

Date of Birth:

Age & Grade:

Participant Email:

Participant cell:

Parent/Guardian Name(s):

Relationship:

Cell phone number(please specify whose if adding multiple)

Parent/Guardian Email address(s):

In case of emergency:

Relationship:

Phone:

Question Title

* 2. I, the parent/guardian listed above, grant permission for my child(the participant listed above) to participate in youth ministry meetings. I understand that meetings will take place under the guidance and direction of parish employees and/or volunteers from the parish. Please check which events your participant will attend. Please select all if there will be able to ever attend any of the following.

NIght events/activities at the parish(i.e. game nights, movie nights etc...)

Sunday meetings from 12:15-2:30pm

Bible studies

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* 3. We are asking parents/guardians to be more involved with Youth Ministry this year. Please indicate which areas you would be willing to help.

Prepare meals for meetings

Chaperone events

Help coordinate and run service projects

Be willing to help during meetings

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* 4. We are going to try to have even better communication this year. Would you prefer a text from the Youth Ministry cell(757-755-0727), through an app such as the Remind app or do you prefer email? Click all the ways you would like to communicated with.

Text from cell phone number

Email

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* 5. I also allow the participant listed above to have photos taken of them. I understand that the photo's taken may be posted on social media sites. I am aware of the St. Therese Youth Ministry Facebook page and Instagram account. I acknowledge that I have been informed of the handler names so I may follow if I so choose.

Yes

No

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* 6. I, certify that as the parent/legal guardian of the participant listed above, I remain legally responsible for any personal action taken by my child. I agree to hold harmless the Church of St. Therese and the Diocese of Richmond as well as its officers, directors, agents, chaperones, or representatives associated with this event, arising from or in connection with my child attending this event, or including but not limited to accidents, emergencies, exposures to reckless conduct of persons. I also understand that if any medical changes occur during this time frame, I am responsible for updating my medical release form with the parish. I understand that submission of my name, parishioner number, and today's date constitutes a legal and binding electronic signature.

Parent/Guardian Name:

Date: