MYO Registration Form

Full Name (Youth Member)*

First NameLast Name

E-mail*

Phone Number

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Birth Date*

MonthDayYear

Parent/Guardian Full Name*

First NameLast Name

Parent/Guardian Phone Number*

Please enter a valid phone number.

Parent/Guardian Email Address*

example@example.com

Emergency Contact Full Name*

First NameLast Name

Emergency Contact Phone Number*

Please enter a valid phone number.

Allergies (please add N/A if it doesn't apply)*

Medications (please add N/A if it doesn't apply)*

Doctor's Name*

Doctor's Phone Number*

Please enter a valid phone number.

Health Insurance Company Name*

Name of the Insured*

Health Insurance Policy ID Number*

Health Insurance Group Number*

Please upload images of the front and back of your Insurance Card*

WAIVER OF LIABILITY: As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above-named minor (“participant”). I agree on behalf of myself and my child named herein to hold harmless and defend Our Lady of the Cedars Church's Maronite Youth Organization under, its directors, volunteers, and representatives and the Eparchy of Our Lady of Lebanon of Los Angeles, its employees and agents, chaperones, and/or representatives associated with the event, from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate Our Lady of the Cedars Church's Maronite Youth Organization, its officers, directors and agents, and the Eparchy of Our Lady of Lebanon of Los Angeles, its employees and agents and chaperones, or representatives associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of Our Lady of the Cedars Church's Maronite Youth Organization or the Eparchy of Our Lady of Lebanon of Los Angeles.

I have read, understood, and agreed on the above.

COVENANT OF BEHAVIOR: As the participant or parent/legal guardian of said participant in the Event, I understand that the directors and staff will strictly enforce the rules governing the event. I agree to abide by all the guidelines as established by the Our Lady of the Cedars Church's Maronite Youth Organization and Office of Youth Ministry of the Eparchy and Our Lady of Lebanon, Los Angeles, CA, and to conduct myself in a CHRISTIAN manner. I am fully aware that I will be expelled from the program if I do not adhere to these guidelines. I, the participant or parent/legal guardian of said participant, accept financial responsibility for any damage to the rooms or property caused to any facility attended. I understand that removal from the event will occur at my own expense should conduct be deemed inappropriate.

I have read, understood, and agreed on the above.

PHOTO/VIDEO RELEASE: I, the participant or parent/legal guardian of said participant, hereby give permission to appear in pictures and videos taken during this event. I understand fully that these media items may be used by the Our Lady of the Cedars Maronite Youth Organization and affiliates. This media will not be shared with any third-party unless deemed necessary or appropriate by the facilitators of the event.

I have read, understood, and agreed on the above.

MEDICAL TREATMENT RELEASE: I, the participant or parent/legal guardian of said participant, fully understand that if serious illness develops or injury occurs, medical or hospital care will be given. However, the staff is not responsible in the case of accidental injury or illness. I further understand that in case of serious illness or injury, the emergency contact provided will be notified. If it is impossible to reach said emergency contact, I request and give permission for EMERGENCY TREATMENT or SURGERY, as recommended by the attending physician.
PARENT SIGNATURE: I give permission for my child to attend MYO events at Our Lady of the Cedars Church for the agree to all the terms and conditions of Our Lady of the Cedars Church and The Eparchy of Our Lady of Lebanon of Los Angeles.

I have read, understood, and agreed on the above.

For more information about the Maronite Youth Organization in Houston, please contact: houtonmyo@gmail.com

Thank you!

MYO Membership Registration

PARENTS & YOUTH: Please read the following statements, and check the box if you agree