Saints in the Making Jr. High Registration

Name*

Last NameFirst Name

Grade*

School*

Date of Birth*

Date

Address*

Street Address

Street Address Line 2

CityState

Parent 1 Name*

First NameLast Name

Parent 1 E-mail*

Phone Number Parent 1 can be reached during program times*

Area CodePhone Number

Parent 1 Alternate Phone Number

Area CodePhone Number

Parent 2 Name

First NameLast Name

Parent 2 E-mail

example@example.com

Parent 2 Phone Number

Area CodePhone Number

Other adult I authorize to act on my behalf if Parent 1 and/or 2 cannot be reached*

List name and phone number

Allergies - Please list all food, medical, and environmental allergies (If none known, please type none)*

The following are special circumstances regarding my child of which you should be aware (please include medical conditions, medications, behavioral problems, etc.)

I hereby grant permission for nonprescription medication (such as pain reliever, throat lozenges, cough syrup) to be given to my child, if deemed advisable.*

Insurance Policy Name and Number

Physician's Name

Physician's Number

Area CodePhone Number

I, as parent/guardian of the undersigned minor, hereby consent and agree to hold harmless, St. Louis Parish, Holy Family Parish and/or the Roman Catholic Archdiocese of Indianapolis, IN and any and all employees or volunteers thereof, for any accident, injury or occurrence arising out of, or in connection with the Junior High Youth Ministry Program.

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 COVID19, or any communicable disease, during youth group events. By signing below, I acknowledge that there is an increased risk to contracting COVID19 by attending youth group activities.

I, the parent or legal guardian of the participant, do hereby grant permission for my child to participate fully in the Youth Ministry Program, including Bible Studies, and all of its activities during my childs' 6th, 7th and 8th grade school years. I give my permission for my son/daughter, in case of an emergency, to be taken to a physician or hospital by either a parent in charge or by parish personnel. I understand that every effort will be made to contact me. If I cannot be reached, I hereby give permission to the physician selected by the parish member in charge or adult chaperone to secure proper treatment for my son/daughter.

Signature*

Due to various allergies of some of our students, snacks should not be brought in from home unless arrangements have been made with the leaders.

Volunteers are always appreciated. If you are able to volunteer your time for any youth group meeting(s), please let us know your availability below. If you have not already done so, please register and complete the Archdiocese’s Safe and Sacred program at least 2 weeks before helping with any youth ministry event. This is all done on-line and will not take long to complete. Go to safeandsacred-archindy.org to get started.

Jr. High Youth Group generally takes place twice a month on Friday’s after school until 5:00 pm, and Bible Study on Monday's after school until 5:00 pm. Below is a list of this school year’s tentative dates. They are subject to change due to weather, retreats or other conflicts with parish activities.

I would love to help organize and lead youth group on a regular basisI would love to help chaperone Friday youth group as needed, please call.I would love to help chaperone Monday Bible Study as needed, please call.I am unable to help with youth group activities at this time.

How would you like to be contacted when help is needed?

(please provide phone number or email address)

Parent/Guardian Name*

Today's Date*

Date

Junior High Youth Group