Saint Mary FWB Edge Registration 2024-2025

Father/Guardian Name

First NameLast Name
Father/Guardian Phone Number

Area CodePhone Number
Occupation
Religion
Mother/Guardian Name

First NameLast Name
Mother/Guardian Phone Number

Area CodePhone Number
Occupation
Religion
Best Email to Reach Parent*
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Teen resides with (please choose appropriate response)*

Both ParentsMotherFatherOther
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Any other information you would like to share?

WAIVER: As the parent or guardian of this child, I authorize participation in Life Teen program. I assume all risks and hazards incidental to such participation both during an activity and en route and do hereby release and waive all claims against Diocese of Pensacola -Tallahassee and Saint Mary Church, its staff, volunteers and participants. I also grant permission for emergency first aid to be given in case of injury and transportation to the hospital, if necessary. I have read and agree to the waiver above. Please sign your name electronically below.
By selecting the "I Accept" box below, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions.
Electronic Signature Waiver*

I accept
Signature*

Clear
MEDIA RELEASE:

It is the promise and commitment of the Diocese of Pensacola-Tallahassee to use pictures and videos from Diocesan and/or parish youth events in a dignified and respectful manner.

I hereby authorize the Diocese of Pensacola-Tallahassee, including its parishes, schools, and institutions (hereinafter referred to as “Diocese of Pensacola-Tallahassee”) to use, prepare, reproduce, record, video tape, publish, distribute, broadcast, electronically store, and exhibit my name, image, portrait, likeness, words, and/or voice in connection with interviews, sessions, or events conducted, sponsored, or arranged by the Diocese of Pensacola-Tallahassee and its employees, volunteers, and agents. I acknowledge that any notes, photographs, motion pictures, digital images, recordings, or other media format taken of me will become the property of the Diocese of Pensacola-Tallahassee, and I specifically waive any right to compensation for the foregoing. I understand that my likeness, name, image, or voice may be used by the Diocese of Pensacola-Tallahassee without limitation for any professional purpose, now or in the future, and I consent to the same. This permission extends to any authorized print or broadcast media organization that may participate in such preparation, use, reproduction, publication, or distribution.

I release the Diocese of Pensacola-Tallahassee and its employees, volunteers, agents, and designees from liability for any violation of any personal or proprietary right I may have in connection with such use. I also hereby waive any right I may have to inspect and approve in advance the photographs, videos, sound recordings, or publications or media in which I am included. I agree to release the Diocese of Pensacola-Tallahassee and its employees, volunteers, agents and designees from any liability by virtue of the use of the photographs or video recordings, regardless of any blurring, distortion, optical illusion, or alteration which may occur when the photographs or videos are taken, printed, or displayed.
In regard to the media release above:*

I agree to it.I do not agree to it.
Initials*

I am able to help with:

Donating snacksDonating water/drinksVolunteering my time
As the parent or guardian of this child, I understand my Edge registration is not complete without payment.

Registration Fees are $70 per teen 6th-12th grade; Family cap $140 total for teens in 6th-12th grade

Or please pay with cash/check at the parish office or mail your check to:

Saint Mary Catholic Church
ATTN: Life Teen
110 Saint Mary Ave SW
Fort Walton Beach, FL 32548
I understand my registration is not complete until payment is made.*

I plan to pay online with the "Thank You page" after clicking the "Submit" button belowI plan to pay cash/check at the parish office Mon-Thurs 8:30am-3pm
Questions?

Email: julieanne.walker@saintmary.life

Call 850-243-3742
Should be Empty:

Saint Mary FWB Edge 2024-2025