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Youth Ministry Registration

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  Parent Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Additional Emergency Contact Information (Name and phone #) REQUIRED Please fill out this field. Please enter valid data.
  
  How Many Children? REQUIRED Please fill out this field.
  
  Child 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  School child attends REQUIRED Please fill out this field. Please enter valid data.
  
  What grade is your child in? REQUIRED Please fill out this field. Please enter valid data.
  
  Does your child have any allergies? REQUIRED Please fill out this field. Please enter valid data.
  
  Does your child have any learning challenges? Please enter valid data.
  
  I, the parent and/or legal guardian, grant permission for my child to participate in St. Patrick Catholic Church Youth Ministry. I agree to hold harmless St. Patrick Catholic Church, its employees and agents, chaperones or representatives associated for these events from any claims, damages to personal property, or injury which may result during these events, unless such claim arises from the negligence of the parish or diocese. I understand that St. Patrick Catholic Church will not be liable if my child fails to cooperate with the rules and regulations, and that any infraction of the rules may result in my child's dismissal from the Youth MInistry program.
  
  Child 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  School child attends REQUIRED Please fill out this field. Please enter valid data.
  
  What grade is your child in? REQUIRED Please fill out this field. Please enter valid data.
  
  Does your child have any allergies? REQUIRED Please fill out this field. Please enter valid data.
  
  Does your child have any learning challenges? Please enter valid data.
  
  I, the parent and/or legal guardian, grant permission for my child to participate in St. Patrick Catholic Church Youth Ministry. I agree to hold harmless St. Patrick Catholic Church, its employees and agents, chaperones or representatives associated for these events from any claims, damages to personal property, or injury which may result during these events, unless such claim arises from the negligence of the parish or diocese. I understand that St. Patrick Catholic Church will not be liable if my child fails to cooperate with the rules and regulations, and that any infraction of the rules may result in my child's dismissal from the Youth MInistry program.
  
  Child 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  School child attends REQUIRED Please fill out this field. Please enter valid data.
  
  What grade is your child in? REQUIRED Please fill out this field. Please enter valid data.
  
  Does your child have any allergies? REQUIRED Please fill out this field. Please enter valid data.
  
  Does your child have any learning challenges? Please enter valid data.
  
  I, the parent and/or legal guardian, grant permission for my child to participate in St. Patrick Catholic Church Youth Ministry. I agree to hold harmless St. Patrick Catholic Church, its employees and agents, chaperones or representatives associated for these events from any claims, damages to personal property, or injury which may result during these events, unless such claim arises from the negligence of the parish or diocese. I understand that St. Patrick Catholic Church will not be liable if my child fails to cooperate with the rules and regulations, and that any infraction of the rules may result in my child's dismissal from the Youth MInistry program.
  
  Child 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  School child attends REQUIRED Please fill out this field. Please enter valid data.
  
  What grade is your child in? REQUIRED Please fill out this field. Please enter valid data.
  
  Does your child have any allergies? REQUIRED Please fill out this field. Please enter valid data.
  
  Does your child have any learning challenges? Please enter valid data.
  
  I, the parent and/or legal guardian, grant permission for my child to participate in St. Patrick Catholic Church Youth Ministry. I agree to hold harmless St. Patrick Catholic Church, its employees and agents, chaperones or representatives associated for these events from any claims, damages to personal property, or injury which may result during these events, unless such claim arises from the negligence of the parish or diocese. I understand that St. Patrick Catholic Church will not be liable if my child fails to cooperate with the rules and regulations, and that any infraction of the rules may result in my child's dismissal from the Youth MInistry program.
  
  Child 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  School child attends REQUIRED Please fill out this field. Please enter valid data.
  
  What grade is your child in? REQUIRED Please fill out this field. Please enter valid data.
  
  Does your child have any allergies? REQUIRED Please fill out this field. Please enter valid data.
  
  Does your child have any learning challenges? Please enter valid data.
  
  I, the parent and/or legal guardian, grant permission for my child to participate in St. Patrick Catholic Church Youth Ministry. I agree to hold harmless St. Patrick Catholic Church, its employees and agents, chaperones or representatives associated for these events from any claims, damages to personal property, or injury which may result during these events, unless such claim arises from the negligence of the parish or diocese. I understand that St. Patrick Catholic Church will not be liable if my child fails to cooperate with the rules and regulations, and that any infraction of the rules may result in my child's dismissal from the Youth MInistry program.
  
  Child 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  School child attends REQUIRED Please fill out this field. Please enter valid data.
  
  What grade is your child in? REQUIRED Please fill out this field. Please enter valid data.
  
  Does your child have any allergies? REQUIRED Please fill out this field. Please enter valid data.
  
  Does your child have any learning challenges? Please enter valid data.
  
  I, the parent and/or legal guardian, grant permission for my child to participate in St. Patrick Catholic Church Youth Ministry. I agree to hold harmless St. Patrick Catholic Church, its employees and agents, chaperones or representatives associated for these events from any claims, damages to personal property, or injury which may result during these events, unless such claim arises from the negligence of the parish or diocese. I understand that St. Patrick Catholic Church will not be liable if my child fails to cooperate with the rules and regulations, and that any infraction of the rules may result in my child's dismissal from the Youth MInistry program.
  
  Release of Liability
  
  Submit
  
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