Youth Group Registration Form

Youth Group (YG) Participant*

First NameLast Name

YG Participant Email*

example@example.com

Confirm YG Participant Email*

YG Participant Cell*

Please enter a valid phone number.

Grade or Young Adult/Chaperone*

Please list the Parish, then City you belong to. for ex: St. Wendelin, Luxemburg *

Please list any medical or allergy information we should be aware of.*

Primary Parent Contact Name *

First NameLast Name

Primary Parent Contact Cell *

Please enter a valid phone number.

Primary Parent Contact Email*

example@example.com

Emergency Contact (other than Primary Contact)*

First NameLast Name

Emergency Contact (other than Primary Contact) Phone Number*

Please enter a valid phone number.

Please upload a headshot of participant. We have a lot of new faces and want to make sure we can identify anyone participating in our collaborative youth group if there is an emergency.

Medical Authorization:
I understand that the Diocese of St. Cloud and All Called to Christ/ Holy Saints ACC have no responsibility for accidents which may occur in association with youth group events and activities. I agree to use my own personal insurance to cover any such incidents. I understand that in the event in which medical intervention is needed, every attempt will be made to contact the Emergency Contacts listed above. In the event those individuals are not able to be reached, I hereby give permission to any qualified medical staff selected by the event leader to hospitalize, secure medical treatment, and/or order injection, anesthesia, or surgery for Participant as deemed necessary.

Code of Behavior for Youth and Adults: I agree to abide by and or instruct my child to abide by all rules and regulations as outlined by the aforementioned chaperones/representatives. I agree that if participants fail to abide in any way by the rules, that participant can be dismissed from the event and sent home immediately at my expense with no right of refund for any amount in connection therewith from the Holy Saints & All Called to Christ ACC or its chaperones/representatives.

Photo Release:I give permission to the Diocese of St. Cloud and All Called to Christ & Holy Saints ACC to utilize photographic/video images of myself or child. In giving permission, I hereby indemnify and hold harmless the Diocese of St. Cloud, Holy Saints ACC, and All Called to Christ and its agents from any and all responsibility of liability. I understand that I will receive no compensation should any photograph or video be used.

Parent Signature or Young Adult/Adult *

Date*

Date