St. Nick Party Permission Form

St. Nick Party Registration
Event Information

Class/Grade Level : Middle School

Event Description : A Christmas party for the feast of St. Nicholas at the St. Charles Youth Center, 4904 Trier Rd.

Purpose of Event : Community Building and Spiritual Formation

Date / Approx. Time of Check-In : Saturday, December 6 at 9:00am

Date / Approx. Time of Departure : Saturday, December 6 at 12:00pm

Vincent Wallace and Anna Laisure are in charge of this event. Anna's emergency contact info is (260) 255-5748.
Are you registering a youth participant or as an adult chaperone?

Youth ParticipantAdult Chaperone

Adult Chaperone Registration
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.

Parent/Guardian Permission and Release
Youth Participant Name*

First NameLast Name
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Email*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.
I allow my child to participate in the parish event trip to the Cathedral of the Immaculate Conception on Wednesday, July 30 from 9:00am-12:45pm.

In consideration of the aforementioned participant, my child, being allowed to participate in this event, I, on behalf of myself, my child and my child’s other parent/guardian, hereby acknowledge recognition that such an activity may expose my child to risks and hazard not ordinarily encountered in the parish youth ministry program. Further, on behalf of myself, my child, and my child’s other parent/guardian, I hereby release and agree to hold harmless the above named parish and the Diocese of Fort Wayne-South Bend, Inc. to the fullest extent permitted by law from any and all claims, judgments and liability of every kind for any injury and damage of any kind, whether personal or property, that we or any one of us may suffer or incur due to my child’s participation in the event, regardless of whether the injury or damage is attributable to the fault of parties other than the Parish or Diocese or attributable to the fault, including negligence, of the Parish or Diocese.

I have instructed my child to follow the rules of conduct as directed by the parish youth ministry program and Diocese.
Below is a question about our Annual Emergency Medical Care Forms.

Note: If your child participated in our fall kickoff event on September 7, we already have this information on file, and you can select "Yes".

If you are uncertain if you've completed this form during this academic year, please contact Anna Laisure at alaisure@scbfw.org.
Have you completed a St. Charles Annual Emergency Medical Care Form for your child in the 2025-2026 academic year or since July 1, 2025?*

YesNo
*A new Event Participation form must be completed for each Event. Information provided in the Annual Emergency Medical Care Form will apply to each Event in which your child is allowed to participate during the Youth Ministry Program year. Parents/guardians are responsible for updating the information on that form should changes occur during the Youth Ministry Program year.

Annual Emergency Medical Care Form
Below is our Annual Emergency Medical Care Form. For your convenience, we have embedded it into the general retreat registration form. However, this is technically a separate form which is why you have to type your name and email again. It has a GREEN "Submit" button.

After clicking the GREEN "Submit" button, please be sure to scroll to the bottom of this page and click the BLUE "Next" button.

THERE IS ANOTHER PAGE AFTER THIS! Your registration is not complete yet, so do not close out of this tab!
Please check before moving on.*

I am verifying that I have signed and submitted the above Annual Emergency Medical Care Form for my child.

Thank you for registering for this event! Please provide a signature below to finalize your registration. If you have questions abour your registration or about the event, please contact Anna Laisure at ym.associate.scbfw@gmail.com.
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St. Nick Party Registration

Adult Chaperone Registration

Parent/Guardian Permission and Release

Annual Emergency Medical Care Form