2025-2026 - St. Emily's Youth Ministry Registration Form

2025-2026 - St. Emily's Youth Ministry Registration Form

Youth Ministry Registration Form

June 1, 2025-August 31, 2026
Please note: Only a parent or guardian may fill out this registration form for their teen.

By registering your teen(s) for Youth Ministry at St. Emily's you are giving them permission to be present at any St. Emily Youth Ministry Events, volunteer opportunties, or local events which we may attend as a group. This may include, but are not limited to events such as going to "Feed My Starving Children", attending movies at the theater, etc. An additional permission form will be provided for any longer field trips or overnight stays.

Participation in any of our Parish events for teens is based on each teen's own availability and by completing this form you do not commit to attend a certain number of events.

Because of this, the staff and volunteers of St. Emily will only be responsible for your teen(s) when they arrive at each individual event and until they depart. Parents are expected to arrange for the drop off and pick up of their teen(s) from each event and to communicate to parish staff if they have any concerns about procedures in this area. Unless otherwise instructed by the parents, parish staff and volunteers will assume that each teen is responsible and can be trusted to know who he/she is going home with and to otherwise manage his/her own transportation and pick-up
Parish Information
Which Parish do you belong to?*
Are you registered at your parish? Not necessary, but helpful. For more information about the benefits of being registered at your parish and how to do so please contact your parish office.
Parent or Guardian Information
Parent (or Guardian) 1*

First NameLast Name
Relationship to Student*
Phone Number*
Please enter a valid phone number.
Type*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent (or Guardian) 2*

First NameLast Name
Relationship to Student*
Phone Number*
Please enter a valid phone number.
Type*
Email*
example@example.com
YesNo
2nd Parent or Guardian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Both parentsFatherMotherOther
If "Other", please explain
If parents are divorced, please indicate who has legal custody of the student (s)*
If "Other", please explain
Is there any other information regarding the legal custody of the student(s) or family situation which might be helpful for us to know?

Student Information
How many Students (7th-12th grade) are you registering for Youth Ministry Events?*

Emergency Information
Additional Emergency Contact (cannot be a parent or guardian) In case of emergency, parents will be contacted first and only if they are not available will we contact the Additional Emergency Contact*

First NameLast Name
Relationship to the Student*
Additional Emergency Contact Phone Number*
Please enter a valid phone number.
In the event that the undersigned, or my (our) additional emergency contact cannot be reached and in the judgement of Molly Spiering or an authorized representative, or any other staff member of St. Emily Parish, there is a necessity for immediate examination and/or treatment of my (our) child, I (we) hereby authorize any of the aforesaid personnel to obtain for my (our) child such medical services as are deemed necessary. This release and authorization is valid for June 1, 2025-August 31, 2026. By providing my electronic signature below, I agree to the aforementioned terms and conditions. I also understand that the additional emergency contact listed cannot be a parent/guardian. Signature for Authorization of Medical Treatment:*

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Photo/Media Waiver
YesNo
Signature: I hereby authorize and give my full consent to St. Emily's Parish the use of my child(ren)’s image (photographs, video, and/or audio) and further agree that St. Emily's Parish may use these photographs, video or audio files for promotional materials.

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