2024-2025 Life Teen Registration

2024-2025 Life Teen Registration

Welcome to St. Paul Life Teen where our mission is to lead teens in grades 9-12 closer to Christ and His Church!
In order to streamline communication and expidite registration for St. Paul Life Teen Events, we are asking that one form be filled out, in its entirety, per teen. Information submitted will be treated as strictly confidential.

Unless otherwise noted, this form will cover all St. Paul Life Teen sponsored events (i.e. regualar youth nights, service projects, off campus events)

For any further questions, please contact the Director of Youth & Young Adult Minsitry, Joshua Kay at j.kay@stpaulkensington.org.
Youth Information

Please fill out all required fields
Youth Name:*

First NameLast Name
Youth Date of Birth:*

MonthDayYear
Date
School:*
Class Of (High School Graduation Year):
2025, 2026, 2027, etc.
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Youth Cell Phone:
Phone numbers will only be used for Remind App communion. See parish website for details.Format: (000) 000-0000.
Youth Email:*
example@example.com
Parish (If not St. Paul):
Parent/Guardian Information

Please fill out all required fields
Parent/Guardian 1 Name:*

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

First NameLast Name
Parent/Guardian 2 Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 2 Email:
example@example.com
Youth Medical Information

Please fill out all required fields
Yes, please fill out box on the rightN/A, skip to next question
Allergies:
Yes, please fill out the box on the rightN/A, skip to the next question
Dietary Restrictions:
Yes, please fill out the box on the rightN/A, skip to next question
Please list medication name & dosage:
Medical Conditions & Disabilities (Is there anything we should be aware of? Do you require special assistance during the event/program?)
Insurance Provider:
Policy Number:
Primary Policy Holder:
In Case of Emergency, Please Contact:*

First NameLast Name
Emergency Contact Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Relation to Youth:*
Consent
MEDICAL CONSENT

I understand that my youth will be responsible for his/her own administration of medication, "self-directed." I understand that the volunteer leaders of the Roman Catholic Archdiocese of Hartford and St. Paul Church are not licensed health care professionals and take no responsibility to supervise the administration of required medications, which as stated above is to be "self-directed" by my youth.

In consideration of the acceptance of this self-directed permission, I hereby, for myself, my heirs, executors, administrators and assigns, waive and release any and all claims for damages I may have against the Roman Catholic Archdiocese of Hartford and St. Paul Church, their representatives, employees, successors and assigns, arising out of any and all injured sustained.
YesNo
IMAGE & LIKENESS CONSENT (Youth Photo/Video Release)

I hereby authorize and give my consent for the taking of pictures (moving or still) and for their reproduction or posting on social media (facebook/twitter (X)/periscope/instagram/TikTok/website etc.) for:

1. teaching purposes 2. news release 3. publication 4. community awareness 5. pubilicity and promotion of conference/activities

I understand that I and my child are not entitled to any compensation or rights in the materials and I release St. Paul Church and the Roman Catholic Archdiocese of Hartford from any liability for the use of my child's image for the above stated purpose.
YesNo
TRAVEL CONSENT

I HEREBY GRANT PERMISSION FOR MY CHILD TO BE TRANSPORTED TO AND FROM ANY ST. PAUL LIFE TEEN EVENT BY SAFE ENVIRONMENT TRAINDED VOLUNTEERS IN REGISTERED VEHICLES. I ALSO RELIEVE ST. PAUL AND THE ROMAN CATHOLIC ARCHDIOCESE OF HARTFORD OF ALL RESPONSIBILITY AND CONSEQUENCES THAT MAY ARISE AS A RESULT OF VEHICULAR ACCIDENT OR INJURY.

IN THE CASE OF INJURY I HAVE THE RIGHT TO BE NOTIFIED IMMEDIATELY ABOUT THE EXTENT OF MY CHILDS INJURY.
YesNo
Acknowledgements
As a participant of the St. Paul Life Teen program or Life Teen sponsored events, I understand and agree to the rules and regulations as determined by the Roman Catholic Archdiocese of Hartford and St. Paul Church. I also understand and agree that I will notify my parents or guardian at the time of any infractions requiring my dismissal from the event and that I will be sent home at my own and/or my parent’s or guardian’s expense.

I CERTIFY THAT THE FACTS CONTAINED IN THIS REGISTRATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

I HEREBY GRANT PERMISSION/CONSENT FOR THE ABOVE YOUTH TO PARTICIPATE IN THE EVENT STATED ABOVE WITH THE ROMAN CATHOLIC ARCHDIOCESE OF HARTFORD, AND ST. PAUL CHURCH

I FULLY UNDERSTAND WHAT IS INVOLVED IN THIS EVENT AND I UNDERSTAND THAT I HAVE THE OPPORTUNITY TO CALL THE YOUTH MINISTER OF MY YOUTH'S GROUP.
I agree
Do You Have Any Questions, Comments or Concerns?
I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
Name:*
By typing your name you agree to use it as your legal signature
I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
Name:*
By typing your name you agree to use it as your legal signature
Should be Empty:

2024-2025 Life Teen Registration

Youth Information

Parent/Guardian Information

Youth Medical Information

Consent

Acknowledgements