Clone of Totus Tuus Registration Form

Totus Tuus Registration Form

July 12-17, 2026
Click here for program information and event details.
Parent/Guardian Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian E-mail
example@example.com
Mobile Number
Format: (000) 000-0000.
Work Number
Format: (000) 000-0000.
Home Number
Format: (000) 000-0000.

Child #1

First NameLast Name
Grade in 2025-2026 school year
Allergies, Food restrictions, Medical information, etc.
Would you like to register another child?

Child #2

First NameLast Name
Grade in 2025-2026 school year
Allergies, Food restrictions, Medical information, etc.
Would you like to register another child?

Child #3

First NameLast Name
Grade in 2025-2026 school year
Allergies, Food restrictions, Medical information, etc.
Would you like to register another child?

Child #4

First NameLast Name
Grade in 2025-2026 school year
Allergies, Food restrictions, Medical information, etc.
Would you like to register another child?

Child #5

First NameLast Name
Grade in 2025-2026 school year
Allergies, Food restrictions, Medical information, etc.

Medical Information
Name of an additional parent/guardian or emergency contact in case the primary parent/guardian is not able to be reached.

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name of Family Physician or Medical Provider

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Medical Insurance Company (type "uninsured" if coverage in not in place)
Policy Number

Authorizations and Acknowledgements
I hereby authorize St. Michael Catholic Church and Totus Tuus and its agents to utilize photographic and/or video images of me or my child taken during this event. In giving my consent, I hereby indemnify and hold harmless St. Michael Catholic Church and Totus Tuus and its agents from any and all responsibility of liability. I understand that I will receive no compensation should any photograph and/or video of me or my child be used.
In the event it comes to the attention of the parish chaperones that my child complains of illness, I grant permission for non-prescription medication (such as Tylenol, lozenges, etc.) to be given to the Participant(s) after the Event Leader has contacted the Parent/Guardian listed above.
Medical Authorization:

I understand that St. Michael Catholic Church and Totus Tuus assume no responsibility for accidents which may occur in association with diocesan events and activities. I agree to use my/our personal insurance to cover any such incidents. I understand that, in the event medical intervention is needed, every attempt with be made to contact the persons listed above. In the event those individuals cannot be reached, I hereby give permission to the physician or any other qualified medical staff selected by the event leader to hospitalize, secure medical treatment, and/or order injections, anesthesia, or surgery for the Participant(s) as deemed necessary.
Relase of Liability for Youth and Adults:

I understand all reasonable safety precautions will be taken at all times by St. Michael and Totus Tuus and its employees and agents during the events and activities. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree to indemnify and hold harmless St. Michael Catholic Church and Totus Tuus, its leaders, employees, and volunteer staff from any and all claims arising from or in connection with attending this event.
Code of Behavior for Youth and Adults:

I agree to abide by and/or instruct my child to abide by all rules and regulations as outlined by the aforementioned chaperones/representatives. I agree that if I/Participant fail(s) to abide in any way by the rules, that I/Participant can be dismissed from the event and sent home immediately at my/Participant's expense with no right of reimbursement or refund for any amount in connection therewith from St. Michael Catholic Church or its chaperones/respresentatives.
Parent/Guardian Signature

Payment Information
The cost to attend Totus Tuus is as follows:
- 1 participant - $25
- 2 participants - $40
- 3 or more participants - $50
Fees may be paid with a debit/credit card below or by check made payable to St. Michael. Check payments may be brought to the Parish Office or dropped in the weekend collection basket in a marked envelope.

Financial assistance is available. Reach out to Jennifer Beyer at re@stmichaelsgrfld.org or Fr. Aaron Jenkins for more information.
Payment options

Debit/Credit Card Checkout

1 participant

$25.00

2 participants

$40.00

3 or more participants

$50.00

Total

Credit Card

Should be Empty:

Totus Tuus Registration Form

Click here for program information and event details.

Medical Information

Authorizations and Acknowledgements

Payment Information

Debit/Credit Card Checkout

Credit Card