Altar Servers Registration Form

Altar Server Registration Form 2025-2026

HOLY NAME OF JESUS-ST. GREGORY THE GREAT

Name of Participant or Child

Address

Date of Birth

Date

Email

example@example.com

Cell Number

Please enter a valid phone number.Format: (000) 000-0000.

Name of School Attending

Current grade

Which Sacraments have you received?

Parent/Guardian 1:

Full name

Email

example@example.com

Cell Number

Please enter a valid phone number.Format: (000) 000-0000.

What's your relationship with the child (participant)?

Other

Parent/Guardian 2:

Full name

Email

example@example.com

Cell Number

Please enter a valid phone number.Format: (000) 000-0000.

What's your relationship with the child (participant)?

Other

Primary Emergency Contact Information:

Full Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Relationship:

Are there any medical, physical, or cognitive conditions that the parish staff and liturgy team needs to be aware of, such as allergies, seizures, physical limitations, etc.?

If yes, please describe conditions and any appropriate guidelines for our volunteers. We also recommend speaking directly to the group coordinators.

I give you permission to contact my child (minor) via FLOCKNOTE text in accordance with Safe Environment guidelines.

I give you permission to contact me via FLOCKNOTE text in accordance with Safe Environment guidelines.

I give you permission to contact my child (minor) via FLOCKNOTE email, in accordance with Safe Environment guidelines.

I give you permission to contact me via FLOCKNOTE email, in accordance with Safe Environment guidelines.

I give you permission for my child (minor) to be photographed or recorded on video during the course of parish liturgies and events. By signing, I provide consent for these images to be used in print, electronic, or video form for the promotional purposes of future parish activities.

I give permission to be photographed or recorded during parish liturgies and events. By signing, I consent to the use of these images in print, electronic, or video form for the promotional purposes of future parish activities.

Permission to Participate

I, (parent or guardian), grant permission for my child, to participate in the Holy Name of Jesus-St. Gregory the Great Parish activity.

Hold Harmless Agreement

I, the undersigned participant and/or parent/legal guardian of the named participant, agree on behalf of myself, my child (if applicable), or our heirs, successors, and assigns, to hold harmless and defend Holy Name of Jesus–St. Gregory the Great Parish, its officers, directors, employees, agents, and the Archdiocese of New York, its employees, agents, chaperones, or representatives associated with the event, from any claim arising from or in connection with participation in the event.

This includes any illness or injury (including death) or cost of medical treatment in connection therewith. I further agree to compensate the parish, its officers, directors, and agents, and the Archdiocese of New York, its employees, agents, chaperones, or representatives associated with the event, for reasonable attorney’s fees and expenses incurred in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the parish/diocese.

Signature

Date