Youth Group Registration Form 2026

Name of Participant (minor child):

Birthdate:

Date

Participant's Phone Number:

Format: (000) 000-0000.

Participant's Email:

example@example.com

Name of School attending:

Current grade:

Home Address:

Street Address

Street Address Line 2

Parent/Guardian Information:

Parent/Guardian #1 Full name:

Phone Number:

Please enter a valid phone number.Format: (000) 000-0000.

Phone Number:

Format: (000) 000-0000.

Email:

example@example.com

I am the participant's...

Other

Parent/Guardian #2 Full name:

Phone Number:

Format: (000) 000-0000.

Email:

example@example.com

I am the participant's...

Other

Primary Emergency Contact Information:

Full Name:

Phone Number:

Format: (000) 000-0000.

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.?

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.

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

I give you permission for my child to be photographed or recorded on video during the course of parish liturgies and events. By initialing I provide consent for their image to be used in either print, electronic or video form for the promotional purpose of future activities.

I give permission for my child to self-check in and self-check out of Youth Group without a parent/guardian present.

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:

Youth Group Registration Form 2026 - 2027

Permission to Participate