Youth Group _ Permission Slip 2025

Youth Group Registration Form 2025-2026

Holy Name of Jesus - St. Gregory the Great

Participant's Information:

Name of Participant (minor child):*

Birthdate:*

Date

Participant's Phone Number:*

Please enter a valid phone number.

Participant's Email:*

example@example.com

Address:

School attending:

Current grade:*

Parent/Guardian Information:

Parent/Guardian #1 Full name:*

Phone Number:*

Please enter a valid phone number.

Email:*

example@example.com

I am the participant's...*

MotherFatherStepparentOther

Parent/Guardian #2 Full name:

Phone Number:

Please enter a valid phone number.

Email:

example@example.com

I am the participant's...

MotherFatherStepparentOther

Primary Emergency Contact Information:

Full Name*

Phone Number*

Please enter a valid phone number.

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.?

YesNo

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.*

YesNo

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

YesNo

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.*

Permission to participate:

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

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 of legal guardian:*

Date