Clone of DCYC Individual Participation Form

Individual Registration Form
Welcome to the 2026 Diocesan Catholic Youth Conference: "Take Courage."

Registration is required for every individual in attendance. Please ensure you have all necessary medical and insurance information available before beginning.
- Participants 17 and under: Form must be completed by a parent or guardian.
- Adult Chaperones: Must complete an individual registration form
*You will be asked to provide your group leader’s name and email so they can receive a confirmation notice.

Thank you for joining us—we look forward to seeing you there!
Registration Details
What parish or school are you apart of?*
If you chose other, please describe
N/A if not applicable
Group Leader Name*

First NameLast Name
Group Leader Email*
example@example.com
Registration Type*
Participant First and Last Name*

First NameLast Name
Gender*
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number*
Format: (000) 000-0000.
Email*
example@example.com
T-Shirt Size*

Medical Details
Do you have dietary restrictions or food allergies?*
Dietary Restrictions/Food Allergies*
Emergency Contact First and Last Name*

First NameLast Name
Emergency Contact Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Email Address*
example@example.com
Relationship of Emergency Contact to Participant*
Do you have health insurance?*
Insurance Group Number*
Insurance Company*
Insurance ID Number*
Insurance Cardholder's Name*

First NameLast Name

Parent/Guardian Details
Primary Parent/Guardian Name *

First NameLast Name
Primary Parent/Guardian relationship to participant
Primary Parent/Guardian Home Number*
Please enter a valid phone number.Format: (000) 000-0000.
Primary Parent/Guardian Cell Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Primary Parent/Guardian Email Address*
example@example.com
Would you like to enter information for a secondary Parent/Guardian?*

Secondary Parent/Guardian Details
Relationship of Secondary Parent/Guardian to Participant
Secondary Parent/Guardian Home Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Parent/Guardian Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Parent/Guardian Email Address
example@example.com

RELEASE OF LIABILITY, WAIVER OF RIGHT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS

In consideration for being allowed to participate in this Activity, I release from liability and waive my right to sue the Diocese of Tyler, its parishes, or other affiliated entity(ies) sponsoring the above-named Activity, and all of their respective employees, officers, volunteers, and agents (collectively “Diocese of Tyler”) from any and all claims, including the Diocese of Tyler’s negligence, resulting in any physical injury, illness (including death) or economic loss that I may suffer because of my participation in this Activity, including any travel to, from, and during the Activity.

I am voluntarily participating in this Activity. I understand that there are risks, such as physical and/or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability or even death, which may occur from my participation in this Activity. These injuries or outcomes may arise from my own or other’s actions, inactions, negligence, or from the condition of the Activity location(s) or facility(ies). Nonetheless, I assume all related risks, whether known or unknown to me, of my participation in this Activity, including travel to and from the Activity.

I agree to hold the Diocese of Tyler harmless from any and all claims, loss or damage to my personal property, liabilities and costs, including attorney’s fees, as a result of my participation in this Activity, including travel to and from the Activity. If the Diocese of Tyler incurs any of these types of expenses, I agree to reimburse the Diocese of Tyler.

If I need medical treatment, the Diocese of Tyler is authorized to obtain medical treatment for me. I will be financially responsible for any costs of such treatment. I agree that I will not hold the Diocese of Tyler responsible for any claims
resulting from any medical treatment. I am aware that the Diocese of Tyler does not provide health insurance for me and I should carry my own health insurance.

I am 18 years or older. I have read this document, and I am signing it freely. I understand the legal consequences of signing this document, including (a) releasing the Diocese of Tyler from all liability, (b) waiver of my right to sue
the Diocese of Tyler, (c) and assumption of all risks of participating in this Activity, including travel to and from the Activity.

I understand that this document is written to be as broad and inclusive as legally permitted by the State of Texas. I agree that if any portion is held invalid or unenforceable, I will continue to be bound by the remaining terms.

Adult Consent
"I acknowledge that photo and video will be taken during the event and may be used for future promotion by the Diocese of Tyler."*
"I understand that I must be compliant with my Diocese's Safe Environment policies and must have cleared a background check performed by my Diocese prior to the event."*
Printed Name*

First NameLast Name
Date Signed*

MonthDayYear
Date
Please sign below:*

Minor Consent
If Participant is under 18 years of age:

I am the parent or legal guardian of the Participant. I have read this document, and I am signing it freely. I understand the legal consequences of signing this document, including (a) release of the Diocese of Tyler from all liability on my and the Participant’s behalf, (b) waiver of my and the Participants’ right to sue, (c) and assumption of all risks of the Participant’s participation in this Activity, including travel to and from the Activity. I allow Participant to participate in this Activity. I understand that I am responsible for the obligations and acts of Participant as described in this document. I agree to be bound by the terms of this document.
"I acknowledge that photo and video will be taken during the event and may be used for future promotion by the Diocese of Tyler."*
Minor Participant’s Name*

First NameLast Name
Parent/Guardian Name:*

First NameLast Name
Parent/Guardian Signature*
Date Signed*

MonthDayYear
Date

Registration Summary

We'll be in touch soon to see how we can further support you and your group. If you have any questions until then, please email us at registration@catholicflint.org
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