NY Catholic Youth Day 2025, High School

NY Catholic Youth Day 2025, High School

Parental/Guardian Consent Form and Liability Waiver
Description of Activity or Event

New York Catholic Youth Day will take place on Saturday, September 27, 2025, at St. Joseph’s Seminary (201 Seminary Ave, Yonkers, NY). This event is open to all HIGH SCHOOL STUDENTS (Grades 9–12) from parishes and schools across the Archdiocese, offering a day filled with faith, fellowship, and celebration.

Important Travel Details:
Our group will travel together by bus, departing from Holy Name of Jesus – St. Gregory the Great Parish (207 West 96th St) promptly at 8:00 AM. We expect to return to the parish by 6:00 PM.

This exciting day is organized by the Archdiocesan Office of Youth Faith Formation.
Participant Information
Participant’s name:*
Birth date:*

MonthDayYear
Date
Age:*
Sex:
Phone Number:*
Participant's T-Shirt Size:*
Parent/Guardian's Information
Full Name: *
Home address:*
Phone Number:*
Email:*
example@example.com
What's your relationship with the participant?*

MotherFatherStepparentOther
Permission to Participate
I, First Name* Last Name* (Parent/Guardian), grant permission for my child, First Name* Last Name* (Child’s name) to participate in this event that requires transportation to a location away from the parish/school site. This activity will take place under the guidance and direction of the Archdiocese of New York and parish employees and/or volunteers from Holy Name of Jesus - St. Gregory the Great Parish.
Do you give permission for your child to be photographed or recorded on video during youth ministry events, with their image possibly used in print, electronic, or video form for the promotional purposes of future activities?*

Yes - I give permission.No - I do not give permission.
Hold Harmless Agreement
As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor (“participant”). I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend Holy Name of Jesus - St. Gregory the Great Parish, its officers, directors, employees and agents, and the Archdiocese of New York, its employees and agents, chaperones, or representatives associated with the event, from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the parish, its officers, directors and agents, and the Archdiocese of New York its employees and agents and chaperones, or representative associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the parish/school/diocese.
Signature*

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Date*

MonthDayYear
Date
NY Catholic Youth Day – Program Fee Agreement
I understand that the registration fee for New York Catholic Youth Day is $45 per participant. I agree to submit this payment in person to the event organizer and accept responsibility for paying any late fees if the payment is not made on time (Before September 15th, 2025.)*

Yes, I agreeNo, I cannot pay at this time
Signature*

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I understand that the bus fee for New York Catholic Youth Day is $25 per participant. I agree to submit this payment in person to the event organizer. (please email the event organizer for other payment options at faithformation@hnj.nyc)*

Yes, I agreeNo, I cannot pay
Signature*

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Medical Consent and Permission to Treat

I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. Of the following statements pertaining to medical matters, sign only those that are applicable.
Insurance Information
Family Health Plan Carrier:
Policy Number:
Emergency Medical Treatment: In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor.
Signature of Parent/Guardian*

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Date

MonthDayYear
Date
Primary Emergency Contact Information

In the event of an emergency, if you are unable to reach me at the above numbers, contact:
Full Name:*
Phone Number*
Please enter a valid phone number.
Relationship*
My son/daughter is under the care of a medical provider:

YesNo
Provider Name:
Phone Number:
Other Medical Treatment: In the event it comes to the attention of the parish, its officers, directors and agents, and the Archdiocese of New York, chaperons, or representatives associated with the activity, that my child becomes ill with symptoms such as headache, vomiting, sore throat, fever, diarrhea, I want to be called.
Signature*

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Medications: My child is taking medication at present. My child will bring all such medications necessary, and such medications will be well-labeled. Names of medications and concise directions for seeing that the child takes such medications, including dosage and frequency of dosage, are as follows:
Signature*

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Specific Medical Information

The parish will take reasonable care to see that the following information will be held in confidence.
Allergic reactions (medications, foods, plants, insects, etc):*
Immunizations: Date of last tetanus/diphtheria immunization

MonthDayYear
Date
Does child have a medically prescribed diet?
Any physical limitations?
Is child subject to chronic homesickness, emotional reactions to new situations, sleepwalking, bedwetting, fainting?
Has child recently been exposed to contagious disease or conditions, such as mumps, measles, chicken pox, etc.? If so, list date and disease or condition:
You should be aware of these special medical conditions of my child:
Should be Empty:

NY Catholic Youth Day 2025, High School

Description of Activity or Event

Participant Information

Parent/Guardian's Information

Permission to Participate

Hold Harmless Agreement

NY Catholic Youth Day – Program Fee Agreement

Medical Consent and Permission to Treat

Insurance Information

Primary Emergency Contact Information

Specific Medical Information