2021-22 Team Jesus High School Youth Group

Team Jesus High School Youth Group

High School Youth Group is for all youth in grades 9-12

Teen Participant Information
Participant Name *

First Name Last Name
Gender *
Age *
Date of Birth *

Month Day Year
School Attending *
Grade *
Youth E-mail
by submitting email address you give permission for adult leaders to contact student via email
Youth Mobile Number
by submitting phone number you give permission for adult leaders to contact student via phone for reminders
Would you like to add another youth living in the same household to this registration? *

Additional Teen Participant Information
Participant Name *

First Name Last Name
Gender *
Age *
Date of Birth *

Month Day Year
School Attending *
Grade *
Youth E-mail
by submitting email address you give permission for adult leaders to contact student via email
Youth Mobile Number
by submitting phone number you give permission for adult leaders to contact student via phone for reminders
Would you like to add another youth living in the same household to this registration? *

Additional Teen Participant Information
Participant Name *

First Name Last Name
Gender *
Age *
Date of Birth *

Month Day Year
School Attending *
Grade *
Youth E-mail
by submitting email address you give permission for adult leaders to contact student via email
Youth Mobile Number
by submitting phone number you give permission for adult leaders to contact student via phone for reminders

Parent/Guardian Contact Information
Parent/Guardian Name(s)

Parent/Guardian 1 Parent/Guardian 2
Primary Guardian Home Phone
Primary Guardian Address *

Street Address

Street Address Line 2

City State
Parent/Gaurdian 1 Mobile #
Parent/Guardian 2 Mobile #
Guardian/Parent 1 E-mail *
A confirmation email will be sent to this email address
Guardian/Parent 2 E-mail

Emergency Contact/Medical Information
Emergency Contact Name
Mobile Phone
Home Phone
Insurance Carrier:
Insurance Policy/ID No:
I hereby grant permission for nonprescription medication (such as aspirin, throat lozenges, cough syrup) to be given to my teen(s), if deemed advisable. *

Yes No medication of any type whether prescription or nonprescription may be administered to my teen(s) unless emergency treatment is required.
Medical Conditions/ Allergies *
If registering more than 1 teen, please put teens name with medical information
CONSENT FOR MEDICAL TREATMENT | As the parent or legal guardian of the above-named participant, I hereby give my consent to adult leaders or chaperones to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency, if you are unable to reach me at the above numbers, I hereby give consent to the Emergency Contact person listed above to act on my behalf.

Consent & Liability Information
CONSENT AND LIBILITY WAIVER | As the parent or legal guardian of the above-named participant, I hereby give my consent for said participant to participate in the High School Youth Group and all events within the Greater Batesville Area, including but not limited to, Sunman, Morris, and Oldenburg. I understand that any event or activity which may have additional risks and/or is outside of the Greater Batesville Area will require a separate liability waiver.

I understand that while our youth group leaders are taking every reasonable precaution to prevent the spread of the Coronavirus, these measures cannot prevent contagion 100% and that there is no guarantee anyone will not contract COVID 19, or any communicable disease, during youth group events. By signing below, I acknowledge that there is an increased risk to contracting COVID 19.

I will not hold the Archdiocese of Indianapolis, any Parish within the Archdiocese of Indianapolis, chaperones, leaders, or representatives associated with the Archdiocese and/or parishes, responsible in the event of injury or illness during a Youth Group event. Further, I agree to accept any and all financial responsibility as a result of scheduling necessary emergency medical treatment. 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.

Signature
By signing and submitting this registraiton form, you understand and agree to all policies.

Please be aware that there are times when leaders and/or other students will take pictures during youth events. These pictures may be used to promote future events and may be shared through the parish website and/or social media. Leaders associated with St. Louis Parish will not publish names or information with the pictures, but at times, students will “tag” themselves or their friends if posted on social networking sites.
Signature

Clear
Parent/Guardian Name *

First Name Last Name
Today's Date *

Year Month Day
Should be Empty: