ST ANTHONY'S ALTAR SERVER 2024-25

Altar Server Registration Form
Please note that: All applicants must be baptized Catholic students in grades 4th and above who have received their First Holy Communion, are parishioners at St. Anthony of Padua Church or students at St. Anthony's School, are willing and able to attend training sessions, and have a desire to serve the Lord and His people.

A SEPARATE APPLICATION WILL NEED TO BE COMPLETED
FOR EACH ALTAR SERVER.
ALTAR SERVER FULL NAME*

First NameMiddle NameLast Name
GENDER*
ALTAR SERVER'S BIRTH DATE*

MonthDayYear
Date
CURRENT AGE*
GRADE LEVEN IN FALL 2024*
SERVER’S OR CONTACT CELLPHONE#*
SERVER’S OR CONTACT EMAIL*
example@example.com
Name of School you will be attending in Fall 2024*
Mark the following sacraments you have received*

Baptism1st CommunionConfirmation
YEARS AS AN ALTER SERVER AT ST. ANTHONY OF PADUA*
POSITION AS AN ALTAR SERVER:*

FIRST TIME SERVINGCANDLEBOOKLEADEREPISCOPAL SERVER (when Bishop is the Presider)
If you are a high school student and currently a Team Leader, would you like to be an Episcopal server? (Episcopal Servers assist in the Liturgy when the Bishop is the Presider)*

YesNo
DO YOU ATTEND MASS AT ST. ANTHONY OF PADUA AT LEAST THREE SUNDAYS PER MONTH?*

YESNO
Which Mass do you usually attend with your family:*

SAT 4:00PMSÁBADO 5:30PM ESPAÑOLSUN 8:00AMSUN 9:30AMSUN 11AMDOMINGO 1PM ESPAÑOLSUN 6PM
DO YOU ALTAR SERVE AT ANOTHER CHURCH?*

YESNO
NAME OF CHURCH?
DO YOU HAVE OTHER SIBBLINGS THAT WILL BE SERVING WITH YOU?*

YESNO
NOTE: A SEPARATE APPLICATION WILL NEED TO BE COMPLETED FOR EACH SERVER.
NAME OF (SIBBLING) ALTAR SERVER SERVING WITH YOU

First NameLast Name
NAME OF (SIBBLING) ALTAR SERVER SERVING WITH YOU

First NameLast Name
PARENT'S INFORMATION
MOTHER' NAME

First NameLast Name
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MOTHER'S CELL #*
Please enter a valid phone number.
MOTHER'S EMAIL *
example@example.com
FATHER' NAME

First NameLast Name
FATHER'S CELL#*
Please enter a valid phone number.
FATHER'S EMAIL *
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Is this family currently registered at St. Anthony of Padua parish?*
SERVER’S SIGNATURE*

Clear
PARENT’S SIGNATURE*

Clear
Date received

MonthDayYear
Date

DIOCESAN FORM R22
Diocese of Fresno (DOF) and all Entities of the Diocese of Fresno: Permission for a Minor to Participate in a DOF Activities, Release of Liability, and Consent for Emergency Medical Treatment

Parent / Guardian: In order for your child to attend and/or participate in DOF sponsored events, activities, or sports during this calendar year, you must give your signed permission by completing this NNUALform. In addition to this form, you will also be required to sign permission PR21 Event Forms for your child to participate in specific DOF sponsored events, activities, and sports conducted off parish grounds.

I, the undersigned parent or legal guardian, voluntarily wish to give permission for and request that my child be allowed to attend and participate in DOFsponsored events and activities during this calendar year including those conducted off parish grounds. My child is physically fit and capable of participating in DOF events and activities. I have informed my child to cooperate and conform to the rules, guidelines, and instructions given by DOF personnel or agents, or chaperones, or responsible for DOF events and activities. If requested, I will sign permission and release PR20 Form for each specific event or activity conducted off DOF grounds. I reserve the right to disallow my child to participate in DOF sponsored events by notifying the leader in writing.

I understand that participation in this activity involves some risk (including any travel to and from this activity) and that unforeseen occurrences can arise. I am informed and agree that transportation if involved, may be provided by volunteers, parents, private individuals, or approved commercial operators who are believed to be reliable and insured, but are not under the supervision or control of the Diocese of Fresno.

In exchange for permitting my child to participate in this voluntary activity, I waive and give up all claims (and the right to file a lawsuit) which I or my child (and our successors, heirs, and assigns) may have against DOF. I release and discharge the DOF from all liability or responsibility for death, illness, personal injury, or property damage arising out of DOF activity and any transportation involved with the DOF activities.

In the event of an emergency and if the DOFis unable to contact me, I authorize the DOF personal or other adult leadership of a parish sponsored event or activity, at my expense, to secure and consent to x-ray examination, medical, dental, or surgical diagnosis, treatment, and hospital care advised and supervised by a duly licensed physician, surgeon, or dentist. I expect to be contacted as soon as possible. I agree that if emergency medical or dental services are required for my child, the DOF will not be responsible to pay for any medical or dental expenses. A copy or digital image of this form shall be valid as the original and may be given to the adult leader of parish sponsored activities.

This permission, waiver, release, and consent applies to the DOF named, including but not limited to the Diocese of Fresno Education Corporation; the Roman Catholic Bishop of Fresno (a corporate sole); the Diocese of Fresno; other Fresno Diocesan Parishes and Schools; affiliated organizations and officers; clergy; agents; and employees.

This waiver and release form is signed in order for my child to participate in the DOF sponsored events and activities for my child’s own personal enjoyment and benefit and is done so freely with the knowledge of the risk and dangers that are or may be involved.

I authorize any hospital which has provided treatment to the named participant pursuant to the provisions of Family code section 6910 to surrender physical custody of such minor to the DOF representative upon the completion of treatment. This authorization is given pursuant to Health and Safety Code section 1283.

I, the undersigned, have read this release and understand all of its terms. I request that my child be allowed to participate in DOF sponsored events and activities. I execute this form voluntarily and with full knowledge of its significance. I have discussed the above with my child, and my child is aware of and understands the importance of following all rules set out for these events, activities, or sports. A copy or digital image of this form shall be as valid as the original authorization may be given to the adult leader of the events, activities, or sports.
PRINT NAME OF PARENT / LEGAL GUARDIAN SIGNING THIS FORM*
SIGNATURE OF PARENT / LEGAL GUARDIAN*

Clear
The following information is provided for the benefit of the parish in case of an emergency.
NAME OF EMERGENCY CONTACT (OTHER THAN PARENT / GUARDIAN)*

First NameLast Name
RELATIONSHIP*
EMERGENCY CONTACT CELL PH#*
ALLERGIES FOODS, DRUGS, INSECTS, ETC
IF ANY MEDICATION IS LISTED: FORMS R18 OR R19 MUST BE COMPLETED AND ATTACHED
OTHER INFORMATION
MEDICAL INFORMATION
FAMILY DOCTOR / PHYSICIAN

No Family Doctor / Physician Listed
FAMILY DOCTOR OR MEDICAL GROUP
DOCTOR’S TELEPHONE
INSURANCE

No insurance Listed
INSURANCE COMPANY
POLICY HOLDER’S NAME
INSURANCE GROUP OR ID NUMBER

ANNUAL YOUTH CODE OF CONDUCT AGREEMENT R14 / R15
Diocese of Fresno (DOF) and Entities of the Diocese of Fresno: Code of Conduct Agreement for Participants under the age of 18 and Non-Participating Parents or Guardians.

In order to participate in any youth activities sponsored by DOF, all youth participants, under the age of 18, and a parent o r legal guardian must sign that they have read and agree to the following:

PARTICIPANT AGREEMENT (under the age of 18):

I agree to politely obey the requests and directions of the adult leaders. I agree to stay with my assigned group or buddy at all times.

I agree to participate in the approved activities at all times. I agree to dress appropriately at all times.

If the event involves an overnight stay, I agree to stay in my assigned room and observe the bedtime and quiet hours schedule until group activities begin the next day unless otherwise directed by an adult leader. I agree to be on time to activities and will observe all check-in rules.

I agree to treat others with respect and will not engage in behavior that reflects poorly on me or the group which includes, but not limited to: stealing, swearing, fighting, being physically or verbally abusive, being dishonest, damaging property, threatening others, or engaging in disruptive behavior.

I agree not to participate in hazing, teasing, bullying, or similar activities.

I agree not to engage in any illegal activities including, but not limited to: smoking, using drugs, gambling, possession of tobacco, drugs, or any weapons.

As a participant, I will take responsibility for my actions and understand that I will be sent home if I do not comply with t his Code of Conduct to the satisfaction of the adult leaders.

PARENT / GUARDIAN AGREEMENT (requires signature and all contact information)

I have reviewed the Code of Conduct with my child. He or she understands that the Code of Conduct and promises to

comply with the demands in order to participate.

If my child does not comply with this Code of Conduct to the satisfaction of the adult leaders, I agree to immediately retrieve my child from the activity or event, at my own expense.
SIGNATURE OF PARENT / LEGAL GUARDIAN*

Clear

EVENT - PHOTOGRAPHY RELEASE AUTHORIZATION
Release for Diocesan Production for the Diocese of Fresno (DOF) and all Entities for the Diocese of Fresno (DOF)

Parents / Guardians: This form must be completed in order for your child to participate in this event or function. Please respond accordingly to the authorized use of your child’s photograph or video image in a DOF produced public-relations document.

PARTICIPANT AGREEMENT:

I hereby grant the Diocese of Fresno and its entities (hereinafter called Producer), their nominees, designees, and successors full authorization and the absolute right and permission to sell, assign, convey, reproduce, copyright, use or publish photographic reproductions, portraits, or pictures of me, motion picture or video tape pictures of me, or in which I may be included in whole, in part, or in composite, or in which character or form is distorted, in conjunction with my own or any other picture, product, person, name or reproduction, in color or otherwise, made through any media at its studios or elsewhere, for art, advertising, commerce, business or trade, or any other lawful purpose whatsoever.

I hereby waive any right I may have to inspect or approve the finished product or the advertising copy that may be used in connection therewith, or the use to which it may be applied.

I hereby release, discharge and agree to hold harmless PRODUCER, its nominees, designees, or successors, and assignees or others for whom they are acting from any liability of any nature or description by virtue of any use whatsoever, whether intentional or otherwise, or from any change that may occur or be produced in the taking of said picture or pictures, or any processing tending towards the completion of the finished product, unless it can be shown that said use or change is solely for its purpose of subjecting me to conspicuous ridicule, scandal, reproach, scorn and indignity.
Type a question*

As the parent and/orlegal guardian of the above-named participant, I DO HEREBY CONSENT AND GRANTMY PERMISSION to all of the foregoing.As the parent and/or legal guardian of the above-named participant, I DONOT GIVE MY CONSENT for my child to be photographed, but I understand that itwill be the responsibility of the participanttomake every effort possiblefromparticipatingin any posed pictures. If a picture or pictures are inadvertently taken, then I agree to review the photographsor video within the given time frame in order to identify my child to avoid any reproduction or usage of that image and/or images.
SIGNATURE OF PARENT / LEGAL GUARDIAN*

Clear
Altar servers must have received the Sacraments of Baptism and Eucharist (First Communion) to be able to assist as Altar Servers. Please apply again once you have received these sacraments. Thank you!
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Altar Server Registration Form

PARENT'S INFORMATION

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MEDICAL INFORMATION