Youth Ministry Registration

Youth Ministry Registration

YOUTH INFORMATION
Full Name of Child*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Sex*

MaleFemale
Grade*
Age*
School Name*
Which Sacraments has your child received?*

Baptism1st Reconciliation1st CommunionConfirmation
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

PARENT INFORMATION
Father/ Guardian Full Name

First NameLast Name
Phone Number
Email
example@example.com
Mother/ Guardian Full Name

First NameLast Name
Phone Number
Email
example@example.com

EMERGENCY CONTACT INFORMATION
Full Name of Emergency Contact*

First NameLast Name
Relationship to child*
Phone Number*
Allergic Reactions: (Medications, foods, plants, etc)

Release of Audio and Visual Recording for Purposes of Digital Learning Recordings
I (name of parent/legal guardian), by having my child(ren) receive religious education at Holy Redeemer Catholic Church Parish, and for being allowed access to digital recordings of Holy Redeemer Catholic Church digital learning live sessions and my child/ward's participation in Holy Redeemer Catholic Church digital learning live sessions, expressly assign to Holy Redeemer Catholic Church and the Diocese of Orlando, and to all of their current. former, and future agents and related entities (collectively, "the Diocese"), all rights, title and interest in, and to, the use of my child/ward's image or likeness, including, but not limited to all videotape recordings, photographs, or audio recordings of. or made by, me and/or my child/ward during any and all digital learning classes in which my child participates ("the Property" The Diocese shall have. without my consent. the right to assign its rights in the Property. in whole or in part, to any entity. parish, or school within the Diocese of Orlando for educational purposes.

I hereby irrevocably grant the Diocese perpetually and exclusively, the right to use and incorporate (alone or together with other materials), in whole or in part, the Property. for any other educational purpose. Further, I hereby authorize the reproduction, copyright, exhibition, broadcast and/or distribution of the Property within the Diocese without limitation for any educational purpose whatsoever, and I further waive all rights to any compensation for my and/or my child/ward's appearanceor participation in the Property for these limited educational purposes.

I hereby waive any claims against and release the Diocese, its current. former. and future religious, employees, volunteers, agents, and successors and assigns from and against any and all claims, demands, actions, causes of actions, suits, costs, expenses, liabilities, and damages whatsoever that I and/or my child/ward may have against the Diocese in connection with the Property or the use of the Property for these limited educational purposes.

This release shall not obligate the Diocese to use the Property or to use any of the rights granted hereunder. or to exhibit, distribute. or exploit the Property.

I represent that I am eighteen years of age or older, and that I have read and understand the terms of this Assignment, Waiver, and Release.
Signature of Parent/ Guardian*

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Date

MonthDayYear
Date
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