CCYM (Youth Group) Registration 2021-2022

This form applies to both in-person and online youth group gatherings with the Community Catholic Youth Ministry from July 1, 2021 - June 30, 2022. (This does NOT include some extended day trips or overnight activities - a different form may need to be filled out for those events.)

Student's Name Student's Name First Last
Student's Date of Birth Student's Date of Birth / MM / DD YYYY
Student's Grade (2021-2022)
Parish
Student's Address Student's Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Parent/Guardian Name Parent/Guardian Name First Last
Parent/Guardian Phone Parent/Guardian Phone - ### - ### ####
Parent/Guardian Email
Emergency Contact (if parent/guardian cannot be reached) Emergency Contact (if parent/guardian cannot be reached) First Last
Relationship to Student
Emergency Contact Phone (if parent/guardian cannot be reached) Emergency Contact Phone (if parent/guardian cannot be reached) - ### - ### ####
Special Considerations (allergies, asthma, dietary, accessibility, etc.)
Youth Code of Behavior

The following guidelines will ensure a fun and safe experience for all of us:
1) The possession of alcohol and illegal drugs is clearly prohibited and is cause for dismissal.
2) The Parish/Organization is responsible for the overall actions of the participants.
3) All participants, adults and youth, will be held to the highest Christian standards of morality.

For online meetings:
1) Participants are expected to attend all events on time and participate fully.
2) The Parish/Organization is responsible for the overall actions of the participants.
3) All participants must dress appropriately and participate from a public area of their location that is an appropriate and spiritual environment.
4) All participants, adults and youth, will be held to the highest Christian standards of morality.

I understand and agree to the Youth Code of Behavior. I also understand and agree that my parents or legal guardian will be notified at the time of any infractions requiring my dismissal from the event and that I will be sent home at my own and or parent’s/guardian’s expense.
Student Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Parents/Guardians:

In the event my child is injured or requires immediate and/or emergency care and I cannot be contacted, I authorize the event leaders to act for me according to his/her best judgment (including treatment and/or transportation to area medical facilities). I also authorize area hospital medical personnel to act on my behalf in the event of an emergency and I cannot be contacted.

I know that all possible care and safely will be provided for my child, therefore in case of an accident, to the fullest extend allowed by law, I agree to RELEASE FROM LIABILITY, AND TO INDEMNIFY AND HOLD HARMLESS, the Archdiocese of Washington, Sacred Heart Parish, La Plata; St. Catherine Parish, McConchie; St. Ignatius Parish, Hilltop; priests, deacons, teachers chaperones or representatives associated with the Community Catholic Youth Ministry.

I also agree to release from liability the Archdiocese of Washington, Sacred Heart Parish, La Plata; St. Catherine Parish, McConchie; St. Ignatius Parish, Hilltop; priests, deacons, teachers chaperones or representatives associated with the above event from any liability resulting from injury from, damage to - or damage caused by - my child at the event facility.

The Archdiocese of Washington, Sacred Heart Parish, La Plata; St. Catherine Parish, McConchie; St. Ignatius Parish, Hilltop; priests, deacons, teachers chaperones or representatives associated with the above event assume no liability for lost, stolen or damaged personal property.

I give hereby grant permission to the Archdiocese of Washington, Sacred Heart Parish, La Plata; St. Catherine Parish, McConchie; St. Ignatius Parish, Hilltop; to use any photographs and quotations taken of my child during this event to assist in community awareness, educational efforts, related public relations purposed that may include brochures, posters, website, official social media, and print media.
Signature of Parent/Guardian

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
CCYM Flocknote Messages

CCYM Flocknote Messages I already receive CCYM messages from Flocknote. Please add my contact info to Flocknote Do not add my contact info to Flocknote.
Date Date / MM / DD YYYY

CCYM (Youth Group) Registration 2021-2022

CCYM (Youth Group) Registration 2021-2022

Youth Code of Behavior

Parents/Guardians: