2019-2020 Saint James Youth Ministry

Participant Registration

(Please Print)

PARTICIPANT INFORMATION:

LAST NAME: __________________________________ FIRST NAME: _________________________________

ADDRESS: ____________________________________ CITY: ________________________ ZIP: __________

HOME PHONE #: __________________________ YOUTH'S CELL PHONE #: ____________________________

EMAIL: ______________________________________ T-SHIRT SIZE (Circle One): XS - S - M - L - XL - XXL- XXXL

BIRTH DATE: ___________________________________________ GENDER: MALE / FEMALE

GRADE 2019-2020: ______________ SCHOOL ATTENDING: _________________________________________

PARTICIPANT FAITH FORMATION INFORMATION:

DID YOUR CHILD ATTEND FAITH FORMATION LAST YEAR: NO or YES, And If So... WHERE:____________________

SACRAMENTS CELEBRATED: BAPTISM - RECONCILIATION - EUCHARIST - CONFIRMATION (Circle All Sacraments Celebrated)

If Your Child Has Not Celebrated A Sacrament(s), And Is Ready To Begin Sacramental Preparation Please Contact Joey Gutierrez.

PARENT/GUARDIAN INFORMATION:

PARENT/GUARDIAN #1 NAME: ________________________________________________________________

CONTACT 1 WORK #: __________________________ CONTACT 1 CELL #:____________________________

CONTACT #1 EMAIL: ________________________________________________________________________

PARENT/GUARDIAN #2 NAME: ________________________________________________________________

CONTACT 2 WORK #: __________________________ CONTACT 2 CELL #:____________________________

CONTACT # 2 EMAIL:________________________________________________________________________

FOR OFFICE USE:

Page 1 of 6

_____ Forms _____ $40.00 Payment

_____Insurance Card Copy _____ Baptismal Certificate (Confirmation)

_____ File Completed _____Flock Note Completed

_____ Data Base Completed _____Added to Attendance

2019-2020 Saint James Youth Ministry

Medical Consent/Permission to Treat

(Please Print) To the Best of my knowledge, my child, _____________________________ is in good health, and I assume all responsibility for the health of my child. In the event of an emergency, I give permission to transport my child to a hospital. for emergency treatment. I wish to be advised prior to any further treatment by the hospital or doctor. If you are unable to reach me, please contact: Name:___________________________________

Relationship to Youth:______________________

Contact Number:__________________________ Please provide the following insurance information: Insurance Number:_________________________

Policy Number:____________________________

Please attach a current copy of your child's Health Insurance Card. Medication Information: My son/daughter taking medication and will bring all medication with him/her and it will be clearly labeled. My son/daughter is taking the following medications and directions for taking this medication, including dosage, frequency and storage are as follows: I hereby grant permission for non-prescription medication (such as cough drops, cough syrup, Tylenol, etc.) to be given to my child if necessary. I understand that aspirin will not be given to my son/daughter without my express permission. I grant such permission: Yes / No Participant’s Allergies (including meds and food): Participants Chronic Medical Issues (e.g. diabetes, epilepsy): Participant’s Other Physical Reactions (if any):

_____________________________________ _________________ Parent/ Guardian Signature Date

Page 2 of 6

Acknowledgement of Information and Family Agreement ATTENDANCE: I understand that only 3 absences are permitted per semester. More than 3 absences will result in credit not being awarded towards Sacramental Preparation. We highly encourage regular attendance for all members of our Youth Ministry, not only those in Sacramental Preparation. Please be in regular communication with the Youth Ministry Office about attendance. A calendar is provided, information is posted on our Ministry website found at: www.sjym.org, as well as regular Flocknote Communication.

Our Wednesday Night gatherings begin promptly at 7:00 P.M. Both Life Teen and Edge meet at the Parish Hall for snack. After the snack, Edge reports to the Youth Center for the remainder of the evening and Life Teen remains in the Parish Hall for the duration of the evening. Please make sure your child is on time, so that we can end the evening at 9:00 P.M. Teens are to NEVER leave the Parish Hall without Parent Consent and notification to the Youth Minister. SPECIAL EVENTS, PROJECTS AND GATHERINGS: There will be Special Events, Projects and Gatherings throughout the year. We encourage all members to attend. In the Sacramental Preparation Years some of these events, projects and gatherings are mandatory. Failure to participate will result with a alternative projects, assignments, etc. BEHAVIOR: I understand that while at Youth Ministry functions my child is required to behave appropriately, model good morals, not use language that is considered inappropriate, to dress modestly, and to always respect all people and property around them. I also understand if my child does not follow rules, I will need to pick-up my child from the gathering/event. SNACKS: I understand that snacks are provided by all families involved in the Youth Ministry Program. I agree to keep up with the Snack Schedule which lists the dates my family is scheduled to provide snack. I will adhere to the snack listed and items needed for the snack. I will have snack in the Parish Hall Kitchen no later than 6:30 P.M. . FLOCKNOTE- EMAIL & TEXTING SERVICE: Email & texting are the primary forms of communication for Life Teen and Edge. We will automatically add your families email address(es) and

phone number(s) to Flocknote, our bulk communication provider. Your information will be used only for church purposes. MODEL RELEASE STATEMENT: I hereby GRANT permission for my child registered in Youth Ministry at St. James Catholic Church to be photographed and/or videotaped during Youth Ministry and Youth Ministry events; and for the resulting photographs and/or videotaped footage to be edited, if necessary, and then published and/or broadcast (newspaper, church bulletin, church website etc.) for the purpose of promoting the activities of St. James Catholic Church Youth Ministry and Parish.

COVENANT OF AGREEMENT

I acknowledge and agree to all the information stated above. I understand that my child and family must comply with all rules, expectations and any consequences tied to not adhering to requirements stated above. I grant permission for my child to participate in the St. James Youth Program. I understand this activity will take place under the guidance and direction of parish employees and/or volunteers from St. James Catholic Church. As parent/legal guardian, I remain legally responsible for any personal actions taken by my son/daughter named above. I agree on behalf of myself, my son/daughter named herein, our heirs, successors, and assigns to hold harmless and defends St. James Catholic Church, it’s officers, directors, agents and the Archdiocese of San Antonio from any liability for illness, injury or death arising from or in connection with my son’s/daughter’s attending Youth Ministry, I release the staff, volunteers, etc. from any liability connected with the use of picture or voice recording as part of any of the above similar activities, and I agree to compensate the parish, it’s officers, directors and agents, the Archdiocese of San Antonio, or representatives associated with the event for reasonable attorney’s fees and expenses arising in connection therewith. ____________________________________________________ ______________________________ Signature of Participant’s Parent/Legal Guardian Date ____________________________________________________

Printed Name of Participant’s Parent/Legal Guardian Page 3 of 6

The following will be completed by the Sponsor (Parish Youth Minister) as each event arises.

To Be Completed By Sponsor : Activity (please insert description of the activity/event): __________________________________________________________

_________________________________________________________

Parish/School/Organization (“Sponsor”):

_________________________________________________________

Destination: _______________________________________________

__________________________________________________________

Date(s) of Activity:

__________________________________________________________

__________________________________________________________

Designated Supervisor of Activity: __________________________________________________________

Method of Transportation: ___________________________________

Date and Time of Departure: __________________________________________________________

Date and Time of Return: __________________________________________________________

__________________________________________ Parent/Guardian Name (PRINT)

__________________________________________ Parent/Guardian Name (SIGNATURE)

________________________ Date

***PLEASE COMPLETE NEXT PAGE***

Saint James Catholic Church Youth Ministry

YOUTH EVENT FORM 2019-2020

Page 4 of 6

OFFICE OF YOUTH MINISTRY - ARCHDIOCESE OF SAN ANTONIO

PARENTAL/GUARDIAN PERMISSION, RELEASE, AND LIABILITY WAIVER

PLEASE CARFULLY READ ALL ATERMS BELOW BEFORE SIGNING, THIS DOCUMENT AFFECTS YOU AND YOUR CHILD'S LEGAL RIGHTS

PARTICIPANT'S (YOUTH’S) INFORMATION: (please print)

LAST NAME: ____________________________________________

FIRST NAME: ___________________________________________

ADDRESS: ______________________________________________

CITY: ______________________________ ZIP: ________________

CELL PHONE #: __________________________________________

EMAIL: ________________________________________________

BIRTH DATE: ___________________________________________ GENDER: MALE FEMALE

GRADE 2017-2018: 6th 7th 8th

9th 10th 11th 12th

SCHOOL ATTENDING: ____________________________________

T-SHIRT SIZE (circle one): XS S M L XL XXL XXXL

PARENT/GUARDIAN: _____________________________________

CONTACT #’s: ___________________________________________ EMAIL(S): _______________________________________________ EMERGENCY CONTACT INFO In the event the parent/guardian cannot be reached NAME: _________________________________________________

CONTACT #’s: __________________________________________

RELATIONSHIP TO CHILD: _________________________________ INSURANCE INFORMATION Please include photocopy (front & back) of insurance card.

INSURANCE CARRIER.: ____________________________________

POLICY #: ______________________________________________ HEALTH INFORMATION My son/daughter….

Is allergic to the following: __________________________________

Immunizations are current and up to date: YES NO

Has the following limitations: ________________________________

Experiences homesickness, emotional reactions to new situations,

sleepwalking, fainting, or other conditions we should know about. YES NO Please Explain: ___________________________________________

Is permitted to take, if necessary, non-prescription/over the counter medication (i.e. cough drops, cough syrup, ibuprofen, acetaminophen, etc.)

YES NO

Is taking prescription medication: YES NO (All medications should be in original packaging and clearly labeled with name

of medication, patient’s name, dosage, frequency and storage instructions. Please advise youth minister as to whom will administer the medications.)

In consideration for Participant, a minor child, being permitted by Sponsor to participate in the Activity, which includes transportation to and from the Activity, I, being the undersigned and the parent/legal guardian of Participant, hereby acknowledge, consent, and agree as follows:

I COVENANT, CERTIFY AND REPRESENT TO SPONSOR THAT I AM THE PARENT/LEGAL GUARDIAN OF PARTICIPANT AND THAT I HAVE FULL LEGAL AUTHORITY TO ENTER INTO THIS

AGREEMENT ON BEHALF OF PARTICIPANT. I HAVE (I) FULLY READ THIS AGREEMENT, (II) FULLY UNDERSTAND ITS TERMS, AND (III) AGREE TO BE BOUND BY ALL OF THE TERMS AND

CONDITIONS CONTAINED HEREIN. I UNDERSTAND THAT I, ON MY OWN BEHALF AND ON BEHALF OF PARTICIPANT, HAVE GIVEN UP SUBSTANTIAL LEGAL RIGHTS BY SIGNING THIS

AGREEMENT. I, INDIVIDUALLY AND IN MY CAPACITY AS PARENT/LEGAL GUARDIAN OF PARTICIPANT, SIGNED THIS AGREEMENT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT,

ASSURANCE OR GUARANTEE BEING MADE TO ME BY ANY OF THE CHURCH PARTIES. I INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE BY ME AND

PARTICIPANT OF ALL LIABILITY AGAINST THE CHURCH PARTIES TO THE FULLEST EXTENT PERMITTED BY APPLICABLE LAW.

____________________________________________________ ______________________________ Signature of Participant’s Parent/Legal Guardian Date ______________________________________________________

Printed Name of Participant’s Parent/Legal Guardian Page 5 of 6

1.____________ Initials

2.____________ Initials

3.____________ Initials

4.____________ Initials

5.____________ Initials

6.____________ Initials

7.____________ Initials

8.____________ Initials

1. Consent to Participate and to Transportation. I hereby consent to Participant’s participation in the Activity. I further consent to the transportation of Participant to and from

the Activity by means of the method of transportation designated above.

2. Knowledge of Risks. I acknowledge and agree that I have been advised by Sponsor and that I understand that participation by Participant in the Activity and the transportation

of Participant to and from the Activity may involve serious risks, including, without limitation, death, bodily injury, damage to personal property, and dangers resulting from injury

or accident. Knowing the risks, dangers, and hazards involved in Participant’s participation in and transportation to the Activity, I nevertheless voluntarily consent and agree to

Participant’s participation in and transportation to the Activity. I, INDIVIDUALLY AND IN MY CAPACITY AS THE PARENT/LEGAL GUARDIAN OF PARTICIPANT, HEREBY EXPRESSLY

AND SPECIFICALLY ASSUME FULL RESPONSIBILITY FOR ANY AND ALL RISKS OF DEATH OR BODILY INJURY TO PARTICIPANT OR DAMAGE TO PARTICIPANT’S PERSONAL

PROPERTY RESULTING FROM OR ARISING OUT OF (I) PARTICIPANT’S PARTICIPATION IN THE ACTIVITY, OR (II) SPONSOR’S TRANSPORTATION OF PARTICIPANT TO THE ACTIVITY,

WHETHER CAUSED BY OR CONTRIBUTED BY THE NEGLIGENCE OF THE SPONSOR, THE ARCHDIOCESE OF SAN ANTONIO (THE “ARCHDIOCESE”), OR ANY OF THEIR RESPECTIVE

AFFILIATES, DIRECTORS, OFFICERS, AGENTS, EMPLOYEES, VOLUNTEERS, SUCCESSORS AND ASSIGNS (COLLECTIVELY, THE “CHURCH PARTIES”) OR OTHERWISE.

3. RELEASE AND WAIVER. I, INDIVIDUALLY AND IN MY CAPACITY AS THE PARENT/LEGAL GUARDIAN OF PARTICIPANT, HEREBY, RELEASE, WAIVE, AND FOREVER DISCHARGE

THE CHURCH PARTIES FROM ANY AND ALL LIABILITY, CLAIMS, LOSSES, JUDGMENTS, DAMAGES, COSTS, EXPENSES, AND DEMANDS OF ANY KIND OR NATURE WHATSOEVER,

EITHER IN LAW OR IN EQUITY, RESULTING OR ARISING FROM PARTICIPANT’S PARTICIPATION IN OR SPONSOR’S TRANSPORTATION OF PARTICIPANT TO THE ACTIVITY. I,

INDIVIDUALLY AND IN MY CAPACITY AS THE PARENT/LEGAL GUARDIAN OF PARTICIPANT, HEREBY EXPRESSLY ACKNOWLEDGE AND AGREE THAT (I) THIS RELEASE DISCHARGES

ALL OF THE CHURCH PARTIES FROM ANY AND ALL LIABILITY THAT PARTICIPANT AND I, INDIVIDUALLY AND IN MY CAPACITY AS THE PARENT/LEGAL GUARDIAN OF

PARTICIPANT, MAY HAVE AGAINST THE CHURCH PARTIES WITH RESPECT TO THE DEATH OR BODILY INJURY TO PARTICIPANT OR DAMAGE TO PARTICIPANT’S PERSONAL

PROPERTY THAT MAY RESULT FROM (I) PARTICIPANT’S PARTICIPATION IN THE ACTIVITY, OR (II) SPONSOR’S TRANSPORTATION OF PARTICIPANT TO THE ACTIVITY; AND (II)

THIS RELEASE EXTENDS TO ALL ACTS OF NEGLIGENCE, WHETHER CAUSED BY OR CONTRIBUTED BY ANY OF THE CHURCH PARTIES OR OTHERWISE.

4. INDEMNITY. I, INDIVIDUALLY AND IN MY CAPACITY AS PARENT/LEGAL GUARDIAN OF PARTICIPANT, UNCONDITIONALLY AGREE TO INDEMNIFY, DEFEND, AND HOLD

HARMLESS THE CHURCH PARTIES FROM ANY AND ALL LIABILITY, CLAIMS, LOSSES, JUDGMENTS, DAMAGES, DEMANDS,COSTS AND EXPENSES OF ANY KIND OR NATURE

WHATSOEVER, EITHER IN LAW OR IN EQUITY, (INCLUDING, WITHOUT LMITATION, COURT COSTS AND ATTORNEY’S FEES) INCURRED BY ANY OF THE CHURCH PARTIES

RESULTING OR ARISING FROM (I) PARTICIPANT’S PARTICIPATION IN THE ACTIVITY, OR (II) SPONSOR’S TRANSPORTATION OF PARTICIPANT TO THE ACTIVITY, INCLUDING,

WITHOUT LIMITATION, THE DEATH OR BODILY INJURY TO PARTICIPANT OR DAMAGE TO PARTICIPANT’S PERSONAL PROPERTY THAT MAY RESULT FROM (I) PARTICIPANT’S

PARTICIPATION IN THE ACTIVITY, OR (II) SPONSOR’S TRANSPORTATION OF PARTICIPANT TO THE ACTIVITY, WHETHER CAUSED BY OR CONTRIBUTED BY THE NEGLIGENCE OF

ANY OF THE CHURCH PARTIES OR OTHERWISE.

5. Medical Authorization. In the event of any injury or illness of Participant during the Activity, I hereby authorize and consent to the transportation of Participant to the nearest

medical or dental facility, and, should the need arise, I hereby further authorize and consent to any x-ray, examination, anesthetic, medical or surgical diagnosis and treatment in

the discretion of the attending physician or dentist. I understand that I am giving this authorization in advance of any specific diagnosis, treatment or hospital care being required

and I am providing this authorization to give authority and power to render any care which the medical provider and/or dental provider deems advisable. None of the foregoing

medical or dental treatments shall be withheld if I cannot be reached prior to the administration of such medical and/or dental treatments. I hereby agree that I shall be solely

responsible for the payment of any and all costs for such medical and/or dental treatment of Participant, and in no event shall any of the Church Parties be required to pay for any

such costs or expenses. I, INDIVIDUALLY AND IN MY CAPACITY AS THE PARENT/LEGAL GUARDIAN OF PARTICIPANT, HEREBY, RELEASE, WAIVE, AND FOREVER DISCHARGE THE

CHURCH PARTIES FROM ANY AND ALL LIABILITY, CLAIMS, LOSSES, JUDGMENTS, DAMAGES, COSTS, EXPENSES, AND DEMANDS OF ANY KIND OR NATURE WHATSOEVER, EITHER

IN LAW OR IN EQUITY, RESULTING OR ARISING FROM ANY SUCH MEDICAL OR DENTAL TREATMENT RENDERED TO PARTICIPANT.

6. Photo/Video Consent and Release. I hereby authorize Sponsor and the Archdiocese to take photographs, recordings, and/or videos (whether electronic, digital, or otherwise)

of Participant in connection with the Activity, and I hereby consent to the use, reproduction, and publication of such images by Sponsor and the Archdiocese in connection with

the promotion and publicity of the activities of Sponsor and the Archdiocese, including, without limitation, publication of such images on Sponsor’s website. I, individually and in

my capacity as parent/legal guardian of Participant, hereby waive any right to inspect or approve the actual use by Sponsor or the Archdiocese of any such image of Participant.

Such images of Participant shall be the sole property of Sponsor, and I, individually and in my capacity as parent/legal guardian of Participant, acknowledge and agree that neither

I nor Participant shall be entitled to any compensation whatsoever should any such images of Participant be used by Sponsor or the Archdiocese.

7. COVENANT NOT TO SUE. I HEREBY ACKNOWLEDGE AND AGREE THAT I, INDIVIDUALLY OR IN MY CAPACITY AS PARENT/LEGAL GUARDIAN OF PARTICIPANT, WILL NOT

INSTITUTE ANY SUIT OR ACTION AT LAW, OR OTHERWISE, AGAINST ANY OF THE CHURCH PARTIES OR INITIATE OR ASSIST IN THE PROSECUTION OF ANY CLAIM FOR DAMAGES,

OR CAUSES OF ACTION, WHICH I, INDIVIDUALLY AND/OR IN MY CAPACITY AS PARENT/LEGAL GUARDIAN OF PARTICIPANT, MAY HAVE BY REASON OF INJURY OR DEATH TO

PARTICIPANT OR DAMAGE TO PARTICIPANT’S PERSONAL PROPERTY RESULTING OR ARISING FROM PARTICIPANT’S PARTICIPATION IN THE ACTIVITY OR SPONSOR’S

TRANSPORTATION OF PARTCIPANT TO THE ACTIVITY.

8. Severability. If any term, covenant, or condition of this Parental/Guardian Permission, Release, and Waiver of Liability (the “Agreement”) is, to any extent, invalid, illegal, or

unenforceable, I hereby agree that the remainder of this Agreement shall not be affected thereby, and shall, notwithstanding, remain binding, valid and enforceable to the fullest

extent permitted by law.

YOUTH EVENT FORM Continued

CORE TEAM MEMBERS NEEDED If you are a Confirmed and practicing member of the Catholic Church, please consider serving the parish community as a Core Team Member. This Wonderful Youth Ministry is not possible without volunteers. The youth of our parish need you. If you are interested or would like more information on what is involved, speak with Joey Gutierrez, the parish Youth Minister. The Life Teen/Edge fee is waived for those serving as a Core Team Member.

o Are you interested in serving as a catechist? YES or NO

o If yes, what level are you interested in serving? (circle one) Life Teen or Edge

IF INTERESTED... NAME:_________________________________________

and a good time that we can call you? Mornings / Evenings / Any Time (please circle)

Page 6 of 6