2024-2025 Cross+Training Returner Application

2024-2025 RETURNER APPLICATION

DUE JULY 7TH
NAME:*

First NameLast Name
EMAIL:*
CELL PHONE #:*

Area CodePhone Number
AGE:*
2024-2025 SCHOOL or WORK:*
ADDRESS:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
YEARS ACTIVE IN CT:*
ADULT SHIRT SIZE*
DO YOU NEED A NEW CROSS+TRAINING POLO FOR THIS SEASON?*

YES, I WOULD LIKE A NEW POLONO, I CAN CONTINUE TO USE MY POLO THIS SEASON
WHY DO YOU WANT TO RETURN TO CROSS+TRAINING?*
WHAT DID YOU LEARN FROM YOUR PREVIOUS YEAR AS A CROSS+TRAINER?*
WHAT WERE YOUR WEAKNESSES LAST SEASON? HOW COULD YOU USE THE OFF SEASON TO WORK ON THESE WEAKNESSES BEFORE YOUR RETURN? *
PLEASE LIST ANY CHANGES THAT YOU WOULD LIKE TO SEE IN THIS UPCOMING SEASON (TYPE N/A IF NONE)*

PARENT MEDICAL AND LIABILITY RELEASE STATEMENT

CODE OF CONDUCT & PHOTO RELEASE
DIOCESE OF SANBERNARDINO 1201 E. HIGHLAND AVE., SAN BERNARDINO, CA 92404-4641 (909) 475-5167

CATHOLIC MUTUAL GROUP 2724 WATERMAN AVE STE. J, SAN BERNARDINO, CA 9204-4641 (909) 883-6001

ST. PAUL THE APOSTLE CATHOLIC CHURCH, 14085 PEYTON DR., CHINO HILLS, CA 91709 (909) 465-5503
EVENT: CONFIRMATION RETREATS
LOCATION: ST. PAUL MINISTRY CENTER (3683 CHINO AVE., CHINO, CA 91710)
OFFICE #: (909) 325 8900
DATE & TIME OF ACTIVITY: AUGUST 2024-MAY 2025
NAME*

First NameLast Name
DATE OF BIRTH*

MonthDayYear
Date
EMERGENCY CONTACT NAME*

First NameLast Name
EMERGENCY CONTACT NUMBER*

Area CodePhone Number
FAMILY PHYSICIAN

DR.Last Name
PHYSICIAN CONTACT NUMBER

Area CodePhone Number
INSURANCE COMPANY
INSURANCE POLICY #
ALLERIGES/MEDICAL CONDITONS/DISABILITIES
IS THIS PARTICIPANT TAKING ANY OVER THE COUNTER OR PRESCRIPTION DRUGS?
PLEASE LIST ANY ALLERGIES TO MEDICATIONS OR FOODS:
I also 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 from, I give my permission to the physician or dentist selected by the activity leader to hospitalize, to secure medical treatment and/ order an injection, anesthesia, or surgery for my child as deemed necessary. I understand all reasonable safety precautions will be taken at all times by: St. Paul the Apostle Parishand its agents during the events and activities. I understand the possibility of unforeseen hazards and know there is the inherent possibility or risk. I agree not to hold St. Paul the Apostle Parish, its leaders, employees and volunteers liable for damages, losses, diseases, orinjuries incurred by the subject of this form. I understand that by signing this form I/my child agree(s) to cooperate and participate fully, that I/my child will show respect for the property visited, respect for neighbor, that I/my child will show respect for the law and practice safety skills at all times. By failing to meet this code of conduct, I/my child am/are aware that appropriate action may be taken and arrangements may be made for immediate removal from the event. 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 I otherwise might have to limit if to control such making or use.*

By checking this box, I authorize photos, videotapes or recordings of my child.** READ CAREEFULLY: By checking this box, I DO NOT authorize photos, videotapes or recordings of my child (retreat pictures/videos, etc.)
LIABILITY FORM AGREEMENT SIGNATURE FROM PARTICIPANT*

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CONSENT AND AGREEMENT TO THE CROSS+TRAINING MINISTRY CONDUCT POLICY 2022-2023
I AGREE TO ABIDE BY ALL PERSONAL CONDUCT POLICIES EXPRESSED IN THIS DOCUMENT AND THOSE COMMUNICATED BY THE RETREAT COORDINATOR, CORE TEAM, DCM, PASTORAL ASSOCIATE, AND/OR PASTOR. THE RETREAT COORDINATOR, IN CONJUNCTION WITH THE DCM, AND/OR PASTOR RESERVES THE RIGHT TO MODIFY THIS DOCUMENT AT ANY TIME.

I AGREE TO UPHOLD THIS COMMITMENT THROUGH THE ENTIRE 2024-2025 CROSS+TRAINING MINISTRY SEASON. (AUGUST 2024 - MAY 2025)

I UNDERSTAND THAT CROSS+TRAINING IS NOT A MINISTRY TO NOURISH MYSELF, BUT A PLACE OF SERVICE TO HELP AND GUIDE THOSE TEENS IN THE CONFIRMATION PROGRAM.

I AGREE TO BE BACKGROUND CHECKED AND TO UNDERGO SAFE ENVIRONMENT POLICY TRAINING, CALIFORNIA ABUSE & NEGLECT REPORTING LAW TRAINING (PROTECTING GOD’S CHILDREN TRAINING).
CODE OF CONDUCT CROSS+TRAINER'S SIGNATURE AND AGREEMENT*

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2024-2025 RETURNER APPLICATION

PARENT MEDICAL AND LIABILITY RELEASE STATEMENT

CONSENT AND AGREEMENT TO THE CROSS+TRAINING MINISTRY CONDUCT POLICY 2022-2023