Young Adults Ministry Form

YOUNG ADULTS MINISTRY OF HOLY CROSS CATHOLIC CHURCH

3773 CHAMBLEE TUCKER RD, ATLANTA, GA 30341 Phone no. 770-939-3501
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age*
Email
example@example.com
Phone Number:*
Please enter a valid phone number.
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please select your group.

Young Adult: Ages 19–30
Emergency Information
Emergency Contact's Name

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship:*
Allergies to Food? Please Specify*
Allergies to Medicine? Please Specify*
Do you have any allergies, chronic illness, or medical conditions? If yes, please describe. If the student requires time to take prescribed medications please explain instructions.*
Allergies to Other? Please Specify*
Informed Consent and Acknowledgement I hereby give the content of my participation in any and all activities prepared by Holy Cross Catholic Church during the Youth and Young Adults Ministry of 2025 - 2026 year. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Holy Cross Catholic Church, and all its respective officers, staff, and volunteers from any and all liability for injuries to said child/ren arising out of participation in any of the sessions. In case of injury to said child/ren, I hereby waive all claims against Holy Cross Catholic Church and its respective officers, staff, and volunteers.

Medical Release and Authorization I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention. Permission is hereby granted to the attending physician to proceed with any medical treatment of the person in this application. Permission is also granted to the Holy Cross Catholic Church, including Directors, staff, and volunteers to provide the needed emergency treatment prior to the admission to the medical facility. Release authorized on the dates and/or duration of the registered season for the Youth and Young Adults Ministry Year of 2025 - 2026. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances.
VIRTUS Program Teaching Safety - Empowering God's Children

The Archdiocese of Atlanta is committed to helping children and young people learn and grow in a healthy and safe environment. Holy Cross Catholic Church complies with Archdiocesan Safe Environment policies and procedures.

In accordance with the U.S. Bishop's Charter for the Protection of Children and Young People, the VIRTUS program Teaching Safety - Empowering God's Children is used in the Archdiocese of Atlanta. Students in grades Kindergarten through 12th grade participate in one or two lessons each year.

All employees, and volunteers who regularly work with minors receive the Safe Enrironment training, as well as ongoing training and background screening. More information can be found in the Archdiocese of Atlanta website at https://archatl.com/ministries-services/safe-environment/.
I agree to participate in one of two lessons of the VIRTUS Program explained above. If you select NO, an OPTOUT Form will be sent home to be completed and signed and returned to the Faith Formation Office.*

YESNO
Confirmation and Acknowledgement of the Above Information

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature of Parent/Guardian:*

Clear
Date of Signature:*

MonthDayYear
Date
Should be Empty:

YOUNG ADULTS MINISTRY OF HOLY CROSS CATHOLIC CHURCH