Youth Ministry Registration

Youth Ministry Registration

Please complete this form to register for youth ministry for 2024-2025. This form must be complete prior to your child(ren) attending any youth ministry events.
Youth Ministry Registration
Student Name

First NameLast Name
Student Birthday
MM/DD/YYYY
Student Grade
Student School
Student Email (only if age 13 or older, parent will be copied on all email communication)
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I would like to add an additional child to this registration, for whom the remainder of the parental contacts, medical information, parental consent, waivers, and acknowledgements are the same.
Student #2 Name

First NameLast Name
Student #2 Birthday
MM/DD/YYYY
Student #2 Grade
Student #2 School
Student #2 Email (only if age 13 or older, parent will be copied on all email communication)
example@example.com
I would like to add an additional child to this registration, for whom the remainder of the parental contacts, medical information, parental consent, waivers, and acknowledgements are the same.
Student #3 Name

First NameLast Name
Student #3 Birthday
MM/DD/YYYY
Student #3 Grade
Student #3 School
Student #3 Email (only if age 13 or older, parent will be copied on all email communication)
example@example.com
Parent/Guardian Contact Information
Parent #1 Name

First NameLast Name
Parent #1 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent #1 Email
example@example.com
Parent #2 Name

First NameLast Name
Parent #2 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent #2 Email
example@example.com
Parental Consent Form

I/we the parent(s) or legal guardian(s) of the above named child(ren), a minor, do hereby grant permission for my/our child to participate in St. Joan of Arc Church & Youth Ministry sponsored events, co-sponsored events, special events, service projects and socials, located on or off of St. Joan of Arc church grounds. I/we the parent(s) or legal guardian(s) understand that specific event permission forms may be required at a later date in addition to this form. I/we agree by my/our mutual signature(s) to release, absolve, indemnify and hold harmless St. Joan of Arc Church & St. Joan of Arc Youth Ministry, the Youth & Young Adult Ministry and CYO Office, Catholic Charities and its affiliates, the Roman Catholic Diocese of Cleveland, the Bishop of the Roman Catholic Diocese of Cleveland, and any and all Catholic Churches or Parishes and any and all staff, supervisors, volunteers, organizers or sponsors thereof, and from any and all liability for injury, medical fees, hospital bills, or doctor bills of aforesaid child. I/we waive all claims of any kind against any or all of the organizations or persons hereinabove enumerated, including any and all claims against person or persons transporting aforesaid child to or from any activities hereinabove named.
Signature
Medical Release and Emergency Medical Information

I/we the parent(s) or legal guardian(s) of our child(ren) consent for any official adult representative (volunteer or staff) of St. Joan of Arc Church & St. Joan of Arc Youth Ministry, in the event that all reasonable attempts to contact me/us at the above numbers have been unsuccessful, to seek medical attention and treatment as deemed necessary. This authorization does not cover major surgery unless the medical opinion of two licensed physicians or dentists concurs in the necessity for such surgery and is obtained before surgery is performed. Any and all information concerning the above named child's history including allergies, medication and physical impairments, has been reported in the medical section below. In the event of an emergency, I authorize an adult representative (volunteer or staff) of St. Joan of Arc Church & Youth Ministry to share the completed registration information packet with persons related to the treatment of my child.
Signature
Child's Medical Information
Primary Care Physician Name
Health Insurance Carrier
Name of Policyholder
Member Number
Group Number
Please list any important medical information such as allergies, asthma, special needs, and any medication your child may be taking that a physician or dentist should be alerted:
Photo/Video Release

I/we hereby give my/our consent to St. Joan of Arc Church & Youth Ministry to videotape/photograph our child(ren) without limitation, to use such pictures, film, and/or stories in connection with any of the work of St. Joan of Arc Church & Youth Ministry, including social media and I do hereby release St. Joan of Arc Church & St. Joan of Arc Youth Ministry from any and all claims whatsoever which may arise in said regard. **It is not necessary for you to sign this video/photo release in order for your child(ren) to attend the program. However, it would be to our convenience and assist us in promoting St. Joan of Arc Church & St. Joan of Arc Youth Ministry programs if you would sign it.**
Signature
Acknowledgement

By signing below, I acknowledge that I am the parent or legal guardian of the above named minor child, that I have authority to sign this agreement on my minor child's behalf, and I have read, understand, and agree to the terms and conditions stated above. I/we the parent(s) or legal guardian(s) fully understand that if I/we have any questions about St. Joan of Arc Youth Ministry events I/we may contact Allie Gall, the Coordinator of Youth Ministry at 440-247-4316 (office), 440-666-1474 (cell phone), or via email at agall@stjoanofarc.org.
Signature
Today's Date

MonthDayYear
Date
Should be Empty:

Youth Ministry Registration

Youth Ministry Registration

Parent/Guardian Contact Information

Parental Consent Form

Medical Release and Emergency Medical Information

Child's Medical Information

Photo/Video Release

Acknowledgement