Youth Ministry Form

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Parent's 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.
- Other Parent's full name REQUIRED Please fill out this field. Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Email
  Other email?
  Please enter an email address.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Phone Number Maximum 20 characters Please enter a phone number.
- Home Parish (if not Sacred Heart) Please enter valid data.
- Street 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.
- Number of Children REQUIRED
  Please include each child who will attend Youth Ministry events. You must complete this information for each child.
  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.
  - Date of Birth REQUIRED Please fill out this field. Please enter a date.
  - Gender REQUIRED Please fill out this field.
  - Grade REQUIRED Please fill out this field.
  - School Attending Please enter valid data.
  - Email
    By providing your child's email you agree for your child to receive email communication from YM staff about events. You will always be copied on such communications.
    Please enter an email address.
  - Phone Number Maximum 20 characters
    By providing your child's number you agree for your child to receive text communication from YM staff about events. You will always be copied on such communications.
    Please enter a phone number.
  - Please list any allergies (medications, foods, plants, insects, etc.)
  - You should be aware of these special medical conditions of my child:
- 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.
  - Date of Birth REQUIRED Please fill out this field. Please enter a date.
  - Gender REQUIRED Please fill out this field.
  - Grade REQUIRED Please fill out this field.
  - School Attending Please enter valid data.
  - Email
    By providing your child's email you agree for your child to receive email communication from YM staff about events. You will always be copied on such communications.
    Please enter an email address.
  - Phone Number Maximum 20 characters
    By providing your child's number you agree for your child to receive text communication from YM staff about events. You will always be copied on such communications.
    Please enter a phone number.
  - Please list any allergies (medications, foods, plants, insects, etc.)
  - You should be aware of these special medical conditions of my child:
- 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.
  - Date of Birth REQUIRED Please fill out this field. Please enter a date.
  - Gender REQUIRED Please fill out this field.
  - Grade REQUIRED Please fill out this field.
  - School Attending Please enter valid data.
  - Email
    By providing your child's email you agree for your child to receive email communication from YM staff about events. You will always be copied on such communications.
    Please enter an email address.
  - Phone Number Maximum 20 characters
    By providing your child's number you agree for your child to receive text communication from YM staff about events. You will always be copied on such communications.
    Please enter a phone number.
  - Please list any allergies (medications, foods, plants, insects, etc.)
  - You should be aware of these special medical conditions of my child:
- 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.
  - Date of Birth REQUIRED Please fill out this field. Please enter a date.
  - Gender REQUIRED Please fill out this field.
  - Grade REQUIRED Please fill out this field.
  - School Attending Please enter valid data.
  - Email
    By providing your child's email you agree for your child to receive email communication from YM staff about events. You will always be copied on such communications.
    Please enter an email address.
  - Phone Number Maximum 20 characters
    By providing your child's number you agree for your child to receive text communication from YM staff about events. You will always be copied on such communications.
    Please enter a phone number.
  - Please list any allergies (medications, foods, plants, insects, etc.)
  - You should be aware of these special medical conditions of my child:
- 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.
  - Date of Birth REQUIRED Please fill out this field. Please enter a date.
  - Gender REQUIRED Please fill out this field.
  - Grade REQUIRED Please fill out this field.
  - School Attending Please enter valid data.
  - Email
    By providing your child's email you agree for your child to receive email communication from YM staff about events. You will always be copied on such communications.
    Please enter an email address.
  - Phone Number Maximum 20 characters
    By providing your child's number you agree for your child to receive text communication from YM staff about events. You will always be copied on such communications.
    Please enter a phone number.
  - Please list any allergies (medications, foods, plants, insects, etc.)
  - You should be aware of these special medical conditions of my child:
- 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.
  - Date of Birth REQUIRED Please fill out this field. Please enter a date.
  - Gender REQUIRED Please fill out this field.
  - Grade REQUIRED Please fill out this field.
  - School Attending Please enter valid data.
  - Email
    By providing your child's email you agree for your child to receive email communication from YM staff about events. You will always be copied on such communications.
    Please enter an email address.
  - Phone Number Maximum 20 characters
    By providing your child's number you agree for your child to receive text communication from YM staff about events. You will always be copied on such communications.
    Please enter a phone number.
  - Please list any allergies (medications, foods, plants, insects, etc.)
  - You should be aware of these special medical conditions of my child:
Waivers and Releases
- Please complete the below waivers and relases. These will apply to each child included above. Should you want to provide different information for one child, please submit a NEW form.
- As parent or guardian of my son/daughter, I do hereby agree to allow my son/daughter to participate in Sacred Heart Youth Ministry and all activities and events both on and off Sacred Heart Church property. As parent and/or guardian, I remain legally responsible for any personal actions taken by the above-named minor child.
  
  I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend Sacred Heart Youth Ministry, its parish, clergy, officers, directors, employees and agents, and The Roman Catholic Archdiocese of Washington, its employees and agents, chaperones, or representatives associated with the event, from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the parish, its clergy, its officers, directors and agents, and The Roman Catholic Archdiocese of Washington, its clergy, its employees and agents and chaperons, or representative associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the parish/archdiocese.
  
  I understand that my child’s participation in said activities may require a minimum level of fitness for safe participation, and that the Released Parties do not screen, medically or otherwise, individuals that participate in the activity. I acknowledge that it is my sole responsibility to make certain that my child is physically fit and healthy enough to participate in the activity.
  
  Parent/Guardian Acknowledgment: I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.
  
  I Agree Please select this field.
- I hereby grant permission for non-prescription medication (such as non-aspirin products, i.e. acetaminophen or ibuprofen, throat lozenges, cough syrup) to be given to my child, if deemed appropriate. (Click YES).
  
  No medication of any type, whether prescription or non-prescription, may be administered to my child unless the situation is life threatening and emergency treatment is required. (Click NO)
- Yes or No? REQUIRED Yes No Please fill out this field.
- Emergency Medical Treatment: In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any non-emergency treatment by the hospital or doctor.
- Yes or No? REQUIRED Yes No Please fill out this field.
- Non-Emergency Medical Treatment (If Applicable): In the event it comes to the attention of the parish, its officers, directors and agents, and The Roman Catholic Archdiocese of Washington, chaperones, or representatives associated with the activity that my child becomes ill with symptoms such as headache, vomiting, sore throat, fever, diarrhea, I want to be notified immediately.
- Yes or No REQUIRED Yes No Please fill out this field.
- Photography Release:
  Parents/guardians of participants are advised that photographs or digital recordings of participants may be used in publications, websites or other materials produced from time to time by the parish, Division of Youth and Young Adult Ministry or The Roman Catholic Archdiocese of Washington. (Participants will not be identified, however, without specific written consent.) Please note that the Released Parties have no control over the use of photographs or digital recordings taken by media that may be covering the event in which your child participate(s).
  
  Pictures are taken at all Youth Ministry Events for Sacred Heart Church. These pictures could be used on our Websites and/or Social Media Outlets to promote Parish events.
- Do you consent to the above? REQUIRED Yes, I consent to the photography release. No, I do not. No photographs of my child may be taken. Please fill out this field.
Emergency Contact Information
- Full Name of Contact 1 REQUIRED Please fill out this field. Please enter valid data.
- Phone Number of Contact 1 REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Full Name of Contact 2 REQUIRED Please fill out this field. Please enter valid data.
- Phone Number of Contact 2 REQUIRED Please fill out this field. Please enter valid data.
BY CLICKING I AGREE BELOW, YOU ARE STATING THAT: I HAVE READ THE ABOVE RELEASE AGREEMENT, UNDERSTAND THAT I GIVE UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT VOLUNTARILY.
I Agree Please select this field.

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Sacred Heart Catholic Church

Bowie, MD

Youth Ministry Form

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