St. Paul the Apostle Challenge & Conquest Registration

St. Paul the Apostle, Burlington

CHALLENGE & CONQUEST

Registration Form

(September 2024 - June 2025 season)

Sponsored by Regnum Christi, Love Christ, Serve People, Build the Church

Meetings held every Tuesday from 6.30pm to 8.30pm at:

St Paul Catholic Elementary School

530 Cumberland Ave, Burlington, ON L7N 2X2

Grade 1-4 Annual membership Fee $150 per child

Grade 5-8 Annual membership Fee $150 per child

Grade 9-12 Annual membership Fee $70 per child

Family discount: 10% off for 2 siblings, 20% off for 3 or more siblings

Payment options:

Cash OR e-transfer to ecydburlington@gmail.com

Email: ecydburlington@gmail.com

Website: www.regnumchristiontario.org/ecyd

How many children are you registering? (must be siblings)*

1st Child's Full Name*

First NameLast Name

Date of birth*

Date

Which club will the child be attending?*

Conquest Club (boys)Challenge Club (girls)

Grade*

Allergies/Medical Issues*

T-shirt size*

2nd Child's Full Name*

First NameLast Name

Date of birth*

Date

Which club will the child be attending?*

Conquest Club (boys)Challenge Club (girls)

Grade*

Allergies/Medical Issues*

T-shirt size*

3rd Child's Full Name*

First NameLast Name

Date of birth*

Date

Which club will the child be attending?*

Conquest Club (boys)Challenge Club (girls)

Grade*

Allergies/Medical Issues*

T-shirt size*

4th Child's Full Name*

First NameLast Name

Date of birth*

Date

Which club will the child be attending?*

Conquest Club (boys)Challenge Club (girls)

Grade*

Allergies/Medical Issues*

T-shirt size*

5th Child's Full Name*

First NameLast Name

Date of birth*

Date

Which club will the child be attending?*

Conquest Club (boys)Challenge Club (girls)

Grade*

Allergies/Medical Issues*

T-shirt size*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

By checking this box I acknowledge that I understand that membership in St. Paul the Apostle Challenge & Conquest clubs requires payment of an annual membership fee to cover the club's operating costs.*

Yes

I understand and agree that the success of the St Paul the Apostle Challenge & Conquest programs for my children, depends on every parent’s active participation and commitment. Therefore, I agree to volunteer and participate in the club activities and events.*

Yes

NATURE OF ACTIVITIES: Primarily club meetings as well as formative and sporting activities, consisting of formation in Catholic faith and virtue combined with apostolic projects, online and recreational activities.

ACTIVITY SUPERVISOR (S): Adult Volunteer Staff of the club/program.

TRANSPORTATION: Not Applicable. Participants are responsible for securing their own transportation to and from activities, as the St. Paul the Apostle Challenge & Conquest clubs do not provide transportation.

REQUIREMENTS: The child named above is in good health and has no physical or medical limitations that would cause the activities as described above to be detrimental or dangerous to the child. Parents/guardians should specify allergies and medical problems in corresponding section.

CONSENT: I/We hereby consent to the above-named child’s participation in the activities described above, and specifically request that he be allowed to participate in those activities. I/We warrant that I/We have full authority to legally consent to his participation in the activities described on this form, and all provisions contained herein.

AUTHORIZATION. I/We hereby authorize St. Paul the Apostle Challenge & Conquest clubs to use the image and likeness of my/our child in photograph or video form whether taken by or commissioned by St. Paul the Apostle Challenge & Conquest clubs. in its promotional materials and for its promotional purposes associated with its nonprofit activities. This authorization shall extend to use of my/our child’s image and likeness on the website of St. Paul the Apostle Challenge & Conquest clubs. or its successor in operation or affiliated organization(s) upon written consent of St. Paul the Apostle Challenge & Conquest clubs. I/We understand that this authorization shall survive the end of my/our child’s participation in the activities referenced on this form.

INSURANCE: I/We understand that St. Paul the Apostle Challenge & Conquest clubs do not carry any health insurance relative to the activities or for any injury that may occur to the above-named child. I/We represent that the child is (a) covered by insurance through my/our own insurance carrier; or (b) that I/We am/are personally financially responsible for any and all medical costs incurred as a result of the child’s injury.

EMERGENCIES: If the above-named child requires any emergency medical procedures or treatments during the activities, I/We consent to the activity supervisor(s) taking, arranging for or consenting to such procedures or treatments in the discretion of the activity supervisor(s). For purposes of such procedures and treatments, my/our child’s blood type allergies or other medical problems (if any) are listed in corresponding section.

EMERGENCY CONTACTS: If, in the event of a medical or other emergency, I/We am/are unable to be reached by telephone at the numbers listed below, I/We authorize the activity supervisor(s) to attempt to contact me/us through the alternative emergency contacts listed below.

Emergency Contact 1 (non-signing parent or other)*

NamePhone Number

Relationship*

Relationship

Emergency Contact 2 (non-signing parent or other)

NamePhone Number

Relationship

RELEASE AND INDEMNIFICATION: I/We release and waive, and further agree to indemnify, hold harmless or reimburse St. Paul the Apostle Challenge & Conquest clubs the individual members, agents, directors, officers, employees, volunteers and representatives thereof, as well as activity supervisors, from and against, any claim which I, any other parent or guardian, any sibling, the above-named child, or any other person, firm or corporation may have or claim to have, known or unknown, directly or indirectly, for any losses (including attorneys’ fees incurred by St. Paul the Apostle Challenge & Conquest clubs or any of its individual employees, agents, volunteers, etc. in enforcing this indemnity provision) without limitation in time or amount, damages or injuries arising out of, during, or in connection with my/our child's participation in the activities, the travel to and there from, and the rendering of emergency medical procedures or treatment, if any. I/We understand that this release and indemnification shall survive the end of my/our child’s participation in the activities referenced on this form.

EMAIL AND PHONE MESSAGES COMMUNICATION: Parent's email addresses and phone numbers will be used for St. Paul the Apostle Challenge & Conquest Clubs and ECYD Ontario communication purposes.

I/We have read and understand the above and agree to all terms and conditions contained therein.*

Yes

Date of permission*

Parish*

Parish Name, City*

Parish NameCity

Signing Parent/Guardian *

Full NamePhone Number

Email Address*

Signature*