FNL 2022-2023

FRIDAY NIGHT "LIGHTS" | 2019-2020

ST. PAUL THE APOSTLE CATHOLIC CHURCH, CHINO HILLS
"Before I formed you in the womb I knew you..." | Jeremiah 1:5
EVENT INFORMATION
Friday Night "Lights" (FNL) is an event open to all high school youth at St. Paul the Apostle Catholic Church in Chino Hills. Each FNL is hosted in collaboration between St. Paul Youth Ministry and St. Paul Cross+Trainers. The night includes fellowship, dynamic worship, prayer, and a message focused on the Gospel reading for that weekend.

2022-2023 SEASON DATES:

OCTOBER 28 | JANUARY 20 | APRIL 28 | JUNE 2

CHECK-IN BEGINS 6:30 PM | DOORS OPEN AT 7:00 PM

CONTACT US:

PHONE NUMBER - (909)465-5503 ext. 341

EMAIL - rcordoba@sptacc.org

INSTAGRAM/TWITTER - @spyouthministry
PARTICIPANT INFORMATION
PARTICIPANT'S NAME*

First NameLast Name
DATE OF BIRTH*

MonthDayYear
Date
CELL PHONE NUMBER

Area CodePhone Number
HOME PARISH*

EMERGENCY CONTACT INFORMATION
PARENT'S NAME*

First NameLast Name
PARENT'S PHONE NUMBER*

Area CodePhone Number
EMERGENCY CONTACT PERSON*

First NameLast Name
EMERGENCY CONTACT NUMBER*

Area CodePhone Number
RELATIONSHIP TO PARTICIPANT*

Parent/Legal GuardianSibling (21 or older)Other

MEDICAL LIABILITY
FAMILY PHYSICIAN

First NameLast Name
FAMILY PHYSICIAN PHONE NUMBER

Area CodePhone Number
INSURANCE COMPANY
POLICY NUMBER
PLEASE LIST ANY ALLERGIES, MEDICAL PROBLEMS, OR DISABILITIES:*
IF NONE, PLEASE TYPE: N/A

AGREEMENTS

TO BE SIGNED BY PARENT OR LEGAL GUARDIAN
By signing this box, I understand that in the event medical intervention is necessary, every attempt will be made to contact immediately the persons listed on this form. If I cannot be reached in an emergency during the activity dates shown on this form, I give my permission to the physician or dentist selected by the activity leader to secure medical treatment as deemed necessary.*
Initials
By signing this box, I understand all reasonable safety precautions will be taken at all times by St. Paul Youth Ministry and its agents during the events. I understand that the possibility of unforeseen hazards and know there is an inherent possibility of risk. I agree to not hold St. Paul the Apostle, its leaders, employees, and volunteers liable for damages, losses, diseases, or injuries incurred by the subject of this form.*
Initials
I understand that by signing this box, my child is to cooperate and participate fully, that my child will show respect for the property visited, respect for neighbor, respect for the law, and will practice safety skills at all times. By failing to meet this code of conduct, I am aware that appropriate action may be taken and arrangements may be made for immediate removal from the event.*
Initials
I hereby authorize the making of photographs, motion pictures, videotapes, recording, or other memorializing of said event and my child's participation therein, and the publication and duplication or other use thereof. I hereby waive any rights to compensation or any right that otherwise might have to limit if to control such making or use.*

By selecting this, I DO authorize any photos, videotapes, or recordings of my child.By selecting this, I DO NOT authorize any photos, videotapes, or recordings of my child.
PARENT SIGNATURE*
PARTICIPANT SIGNATURE*
Should be Empty:

FRIDAY NIGHT "LIGHTS" | 2019-2020

PARTICIPANT INFORMATION

EMERGENCY CONTACT INFORMATION

MEDICAL LIABILITY

AGREEMENTS