• High School Youth Ministry Registration 2025-2026

    High School Youth Ministry Registration 2025-2026

    *please complete one form for each participant
  •  - -
  • Format: (000) 000-0000.
  • Family Information

  • Emergency Contact

  • Other Information

  • We would love for you to join our parish family!

    To learn more about our community or to become an official member of St. Mary of the Mills, go here.

  • Medical Information (Información Médical)

  • For the safety of all, it is important that you identify any health conditions and other needs that may impact your child while at Life Teen. This confidential information is only used to keep students safe and best serve your child.

    The parish will take reasonable care to ensure that the following information will be held in confidence.

     

  • Does your child have any allergies (medications, foods, plants, insects, etc.)? If yes, what symptoms should we watch for, and what should we do in case of a reaction? 

  • Does your child have any physical, emotional, learning, or behavioral conditions (such as a learning challenge or ADD, ADHD, or autism)? If so, please list, and describe any triggers, signs, or helpful strategies. What techniques do you recommend to support your child? What accommodations would be beneficial to your child?

  • Medical Authorizations

    2025-2026
  • Consent for Emergency Medical Treatment: As the parent/guardian of the child named above, I give my permission to youth ministry and parish staff to seek medical attention for my child in the event of an emergency. I give permission for my child to be transported to a hospital for emergency medical or surgical treatment. I understand that the hospital or doctor will make every effort to contact me, but in case they cannot reach me, they may proceed with necessary care. I also authorize the release of medical information if required for the emergency treatment of my child.

  • Medical Insurance: I understand that the religious education program does not provide medical insurance for my child. I agree to provide medical insurance information in case of an emergency.

  • No Medications: No medication of any type (prescription or over-the-counter) will be given to my child unless it's an emergency situation where life-saving treatment is needed.

  • Permission to Administer Over-the-Counter Medication: I hereby grant permission for the program staff to administer the following over-the-counter medications to my child if necessary and as directed on the label: Acetaminophen (Tylenol), Ibuprofen (Advil), Antihistamines (Benadryl), Antacids (Tums, Rolaids), topical Cortisone, and cough drops or throat lozenges. I will be notified before any medication is given.

  • Medical History & Current Health Status: I affirm that the medical information provided above (including any physical, emotional, cognitive, or behavioral conditions and learning disabilities) is accurate to the best of my knowledge, and I will update the program staff should there be any significant changes in my child's medical condition during the course of the program.

  • Youth Ministry Hold Harmless

    2025-2026
  • As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor (“participant”). I agree on behalf of myself, my child or children) named herein, or our heirs, successors, and assigns, to hold harmless and defend St. Mary of the Mills it’s officers, directors, employees and agents, and the Archdiocese of Washington, its employees and agents, chaperons, or representatives associated with the event, from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the parish, its officers, directors and agents, and the Archdiocese of Washington, its employees and agents and chaperons, or representative associated with the event for reasonable attorney’s fees and expenses which may incur 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.

  • Publicity Release (Comunicado de publicidad)

    2025-2026
  • Publicity Release Form

    (Formulario de divulgación de publicidad)

    ---------------------------------------------

    Parish Youth Ministry Program

    (Programa de formación en la fe parroquial)

  • St. Mary of the Mills Catholic Church and the Archdiocese of Washington have opportunities throughout the year to promote Catholic faith formation through news stories in radio, TV, print and electronic media.

    Permission is hereby granted St. Mary of the Mills Catholic Church and the Archdiocese of Washington to use the voice/audio recordings, photographs, video and quotations of         to assist in community awareness, educational efforts and related public relations purposes, including media coverage of parish events and activities and public relations/advertising that may include brochures, posters, print, radio, internet, TV or any other electronic media.


    In exchange for the opportunity to participate in the community awareness programs, educational effort and related publicity endeavors of St. Mary of the Mills Catholic Church and the Archdiocese of Washington, I hereby, agree to release and hold harmless St. Mary of the Mills Catholic Church and the Archdiocese of Washington and their agents, servants and employees from any and all claims, demands, causes of action and/or liability of whatever kind or nature arising out of or connected to the use of said voice/audio recordings, photographs, video and quotations.

  •  - -
  • Should be Empty: