St. Patrick Church Youth Group Registration

BOLD: Youth Group Registration

2025-2026
St. Patrick High School Youth Ministry (BOLD - Becoming Our Lord’s Disciples) invites all high school students, Grades 9-12, to join us for faith formation, community and fun! The mission of BOLD is to foster the spiritual growth of each young person while drawing them to responsible participation in the life, mission, and work of the Catholic Church - to live as disciples of Jesus Christ.

For the safety and protection of every minor, participation in St. Patrick High School Youth Ministry requires a completed registration form.

This form serves as an emergency medical and activity consent form. This will be the only time you will need to fill out a full medical form for the high school youth ministry; however, this form DOES NOT register the student for specific trips or events which would occur off of church property.

**Please complete one registration form per child.**
Student's name:

First NameLast Name
Student's DOB (Date of Birth):

MonthDayYear
Date
Student's Biological Sex:

MaleFemale
Student's Primary Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student's phone number:
Optional
Student's Grade:

Freshman (9th)Sophomore (10th)Junior (11th)Senior (12th)
High School:
Where does the student attend?
Student's Home Parish:
Where is the student's family registered?
Medical Information:
Does the child have any allergies? If so, please describe below:
Does your child carry any medication with them? (inhaler, Epi-pen, etc)? Please provide the name of the medication and general information:
Are there any special considerations staff and/or volunteers should be aware of? If so, please state below:
These information will only be shared with volunteers if it impacts your child's participation and involvement.
Student Information:
Non-prescription medication - please choose one:

NO, medication may NOT be administered to the student unless the situation is life threatening and emergency treatment is required.YES, non-prescription medication CAN be administered if deemed appropriate by staff or volunteers.
In the event of an emergency, I give permission to transport my student to a hospital or medical facility for emergency medical treatment

YES, I grant consentNO, I do not grant consent
If you answered NO above, please state what staff or volunteers should do until you (the parent or guardian) arrive.
Emergency Contact Information:
Mother or Legal Guardian 1:

First NameLast Name
Cell phone number:
Please enter a valid phone number.
Father or Legal Guardian 2:

First NameLast Name
Cell phone number:
Please enter a valid phone number.
Whom above should be contacted first in the event of an emergency?
Diocesan Release Form:
For students to participate in onsite and off-site programming throughout the academic year, the Diocese of Columbus requires a release for students. This ensures staff and adult volunteers can contact you if the need arises. This also ensures the youth ministers are aware of allergies, medications, and any other pertinent information while your child is in the care of St. Patrick Church, London, Ohio.

I give my consent for the above-named student to participate in small group formation and all on-site youth ministry events or programs if she or he chooses.

Events sponsored by the youth ministry will follow the Diocesan policy of transportation, abiding by the Safe Environment driving policy.

Please note, additional permission slips and events costs may apply. Registration deadlines and activity costs will be provided in advance.
I am the parent or legal guardian of the student named above and grant permission for the student to participate in St. Patrick Youth Ministry programming and events on campus.

AgreeDisagree
Social Media:
I am aware that St. Patrick Youth Ministry may use the following platforms to communicate with students, parents and volunteers: email, Flocknote, website.

I GRANT consentI DO NOT grant consent
Photo Release:
By giving photo release consent, you are consenting to allow St. Patrick Church to use photo and/or video images of your child on St. Patrick Church promotional materials and website without the use of a name.

I GRANT consent for my child's picture to be usedI DO NOT grant consent for my child's picture to be used
Code of Conduct/Behavior:
The Participant shall comply with the following:

1. The Participant must stay and participate in the entire event. The Participant may not leave the premises unless accompanied by an adult leader, parent, or legal guardian.

2. The possession or use of alcohol, tobacco, drugs, or weapons of any kind is not permitted.

3. Foul language is not tolerated.

4. The Participant must comply with any and all directions of activity staff.

5. The Participant must respect the rights and property of others. Damage to or defacing of property will be the financial responsibility of the Participant involved and the undersigned.

6. Failure to abide by this Code of Behavior may result in a request to the undersigned to transport the offending Participant from the premises, and the undersigned shall immediately comply with the request.
Release and Indemnification:
A. Release

The undersigned on behalf of the undersigned, the Participant, and the heirs, successors and assigns of the undersigned and the Participant, hereby release, hold the Diocese of Columbus, the Parish, and all current and former employees, agents, clergy, officers and volunteers of the Diocese of Columbus or the Parish harmless from any liability, and discharge from all direct or derivative claims, actions, causes of actions, medical expenses, costs, legal expenses, other expenses and all other damages at law or in equity, known or unknown, direct or indirect, choate or inchoate against the Diocese of Columbus, the Parish and all current and former employees, agents, clergy, officers and volunteers of the Diocese of the Parish, arising from the Participant’s participation in the Activity named above.

B. Indemnification

The undersigned shall indemnify and hold harmless the Diocese of Columbus, the Parish, and all current and former employees, agents, clergy, officers and volunteers of the Diocese of Columbus or the Parish from any claim, liability, suit, judgment, loss, damage, expense, fee or cost (including court costs and attorney fees) arising directly or indirectly from the Participant’s participation in the Activity named above, unless arising from the negligence of an indemnified party.
Signatures:

The undersigned has read, understands, and hereby agrees to and accepts all provisions in this agreement.
Student:

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Parent or Guardian:

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Date Signed:
Today's Date
Should be Empty:

BOLD: Youth Group Registration

Medical Information:

Student Information:

Emergency Contact Information:

Diocesan Release Form:

Social Media:

Photo Release:

Code of Conduct/Behavior:

Release and Indemnification:

Signatures: