2021-2022 Annual St. Albert YM Form

2021-2022 Annual Youth Ministry Form

St. Albert the Great Catholic Community | Louisville, KY
This form is the Annual Youth Ministry Parental Liability Waiver, Permission, and Medical Information for all youth ministry events held on St. Albert the Great's campus from June 1, 2021- May 31, 2022. Please complete this form for each child in your home who will be attending youth ministry events who will be in the 6th-12th Grade during the 2021-2022 school year.
Section 1 - Contact Information
Youth Name:*

First NameLast NameSuffix
School Attending in 2021-2022 Year:*
Grade Level as of Fall 2021:*
Birthdate:*

MonthDayYear
Date
Youth Shirt Size*
Student Cell Number (If Applicable):
Please enter a valid phone number.
Student Email Address (If Applicable):
example@example.com
Parent/Guardian Name (1):*

First NameLast NameSuffix
Parent/Guardian Name (2):

First NameLast NameSuffix
Primary Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Parent Contact Number:*
Please enter a valid phone number.
Contact Number Type:*

CellHomeWork
Primary Parent Email Address:*
example@example.com
Parent/Guardian (2) Contact Number:
Please enter a valid phone number.
Contact Number Type:

CellHomeWork
Parent/Guardian (2) Email Address:
example@example.com
Emergency Contact (Other than Parent/Guardian):*

First NameLast Name
Emergency Contact's Relationship to Youth*
Emergency Contact's Phone Number:*
Please enter a valid phone number.

Section 3 - Youth Ministry Rules & Guidelines

Please have your youth read over and sign. FAILURE TO COMPLY WITH THESE RULES MEANS IMMEDIATE DISMISSAL FROM THE YOUTH MINISTRY FUNCTION. VIOLATING RULES WILL RESULT IN THE PARENTS BEING CONTACTED AND THE YOUTH BEING SENT HOME AT THE PARENTS’ EXPENSE. THE STUDENT WILL NOT BE PERMITTED TO RETURN UNTIL THE MATTER HAS BEEN RESOLVED WITH THE COORDINATOR OF YOUTH MINISTRY, THE YOUTH, AND THE PARENT OF THE YOUTH.
I will respect the right of each person to come and have fun. I will conduct myself in a responsible manner. I will be drug free (this includes alcohol and tobacco). I will respect and cooperate with all adults present. I will remain in the youth room or the other chosen facility until the event is over. I will be responsible for any guest I bring and will inform him/her of the Youth Ministry rules. I will be responsible for my own belongings (ipod, phone, camera, clothing, etc.) I will dress appropriately. I will follow additional rules tailored for each specific event. I will help clean up at the designated time. In signing below, I agree to comply with the above rules and regulations of the St. Albert the Great Youth Ministry program. *

Clear

Section 4 - Annual Permission & Release

Please initial each of the following statements and provide a signature at the bottom to indicate permission.
I hereby allow my child to participate in the St. Albert the Great Youth Ministry Program. I agree to chaperone at least THREE youth ministry activities this year or to help in some other capacity. This digital permission slip will be kept on file for all Youth Ministry events from June 2021 - May 2022 and covers participation in all events held on St. Albert the Great Campus.*
Parent Initial
I give my permission for my child to ride in any vehicle designated by the adult in whose care my child has been entrusted while participating in any St. Albert youth ministry activity.*
Parent Initial
In consideration of permitting my child to attend and/or participate, I do hereby, for myself and my child waive and release any and all claims that I might have against Fr. Dave Harris, Pastor, Emileigh Ledgerwood, the Director of Youth Ministry, or any employee of St Albert the Great, the institution of St. Albert the Great, the Archdiocese of Louisville and any designated driver of a van, bus, car, or other vehicle, for any and all injuries or losses suffered by said child while engaged in the above activities.*
Parent Initial
I also give permission for the use of photographs/video, which may include my child, to be used by St. Albert the Great Youth Ministry and/or the Archdiocese of Louisville for promotional purposes. This includes, but is not limited to, bulletin boards, newsletters, St. Albert the Great website and/or St. Albert Youth Ministry Facebook/Instagram/Twitter.*
Parent Initial
I give my permission for my child to be communicated with through email:*

YesNo
I give my permission for my child to be communicated with through text message:*

YesNo
In signing, I certify all information is accurate to the best of my knowledge on this form and I understand the required rules and regulations that are asked of my child as a participant in the youth ministry program at St. Albert the Great. *

Clear
Should be Empty:

2021-2022 Annual Youth Ministry Form

Section 1 - Contact Information

Section 2 - Medical Information & Release

Section 3 - Youth Ministry Rules & Guidelines

Section 4 - Annual Permission & Release