ROCK 2021 -2022 Registration

Registration year: September 1, 2021 - September 30, 2022
(Required in order to attend any youth ministry event)
Must be 10 years of age by September 30, 2021

NOTE- FOR SOME REASON REGISTRATION DOES NOT ALWAYS WORK IF COMPLETED ON A CELL PHONE

Participant Name Participant Name First Last
School Attending
Grade for the 2021-22 school year
Must be 10 years old by September 30, 2021

Grade for the 2021-22 school year
Must be 10 years old by September 30, 2021 5th 6th 7th
Birthdate Birthdate / MM / DD YYYY
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Parent/Guardian Name
Parent/Guardian phone: Parent/Guardian phone: - ### - ### ####
Parent/Guardian Email
Terms:

I understand that registering for the St. Peter ROCK Retreat commits me/my child to act in an appropriate Christian manner toward both my peers and adults, and to obey the St. Peter Youth Ministry Rules as stated by the St. Peter Youth Minister and Pastor. By signing here, I understand and agree to the above terms.
Parent's 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.
Participant's 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.
MEDICAL INFORMATION AND CONSENT FORM

St. Peter Jr. High Youth Ministry
Must be filled out to participate in any ROCK event
GENERAL INSTRUCTIONS TO PARENTS/GUARDIANS/ADULTS:

Please take care in filling out this form. It provides crucial information for caregivers in the event of illness or medical emergency. Accuracy and thoroughness are encouraged.
ROCK Member's Name ROCK Member's Name First Last
Date of Birth Date of Birth / MM / DD YYYY
Gender

Gender Male Female
Parent/Guardian's Name: Parent/Guardian's Name: First Last
Parent/Guardian's Email
Parent/Guardian's Phone number: Parent/Guardian's Phone number: - ### - ### ####
Parent/Guardian's Phone secondary number: Parent/Guardian's Phone secondary number: - ### - ### ####
Emergency Contact Name
Emergency Contact Phone Emergency Contact Phone - ### - ### ####
SECTION I -- MEDICAL MATTERS -- MANDATORY

As the Parent/Legal Guardian said above, who is currently associated with St. Peter Youth Ministry, I hereby authorize The Youth Ministers and/ or his/her assistants to carry out the wishes I have named (herein) in areas of emergency medical treatment and other cases of illness. This authorization inclusively extends from September 1, 2021, through September 30, 2022. I hereby warrant that, to the best of my knowledge, said person is in good health, and I assume all responsibility for the health of said person.
Parent/Guardian's 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.
Today's Date Today's Date / MM / DD YYYY
SECTION II - EMERGENCY MEDICAL TREATMENT -- MANDATORY

In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency, if you are unable to reach me at the numbers listed herein, contact:
Name: Name: First Last
Relationship to Child:
Phone Phone - ### - ### ####
Family Doctor Name:
Doctor's Phone: Doctor's Phone: - ### - ### ####
Family Health Plan Carrier:
Policy #:
Parent/Guardian's 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.
Today's Date Today's Date / MM / DD YYYY
SECTION III - OTHER MEDICAL TREATMENT

In the event it comes to the attention of the parish, its officers, directors and agents, and the Archdiocese of New Orleans, chaperones, or representatives associated with the activity that said person becomes ill with symptoms such as headache, vomiting, sore throat, fever, diarrhea, I want to be called collect (with phone charges reversed to myself).
Parent/Guardian's 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.
Today's Date Today's Date / MM / DD YYYY
SECTION IV - MEDICATIONS

SIGN ONLY THOSE OPTIONS THAT ARE APPLICABLE
Said person is taking medication at present. Said person will bring all such medications necessary, and such medications will be well-labeled. Names of medications and concise directions for seeing that the said person takes such medications, including dosage and frequency of dosage, are as follows:
Parent/Guardian's 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.
Today's Date Today's Date / MM / DD YYYY
I hereby grant permission for non-prescription medication (such as aspirin, throat lozenges, cough syrup) to be given to said person, if deemed appropriate.
Parent/Guardian's 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.
Today's Date Today's Date / MM / DD YYYY
NO medication of any type, whether prescription or non-prescription, may be administered to said person unless the situation is life-threatening and emergency treatment is required.
Parent/Guardian's 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.
Today's Date Today's Date / MM / DD YYYY
SECTION V -- MEDICAL INFORMATION

The parish will take reasonable care to see that the following information will be held in confidence.
Allergic reactions (medications, foods, plants, insects, etc.):
Does said person have a medically prescribed diet?
Any physical limitations?
You should be aware of these special medical conditions of said person:
COVID WAIVER:

ARCHDIOCESE OF NEW ORLEANS PARENTAL/GUARDIAN COVID-19 CONSENT FORM AND LIABILITY WAIVER
September 1, 2021 - September 30, 2022

We will do our best to follow COVID guidelines, however if you are immunocompromised, live with those that are or if you have any concerns if you should come in contact with COVID, please consider the risks before attending events.

St. Peter Parish will follow applicable state and local standards of conduct
concerning COVID-19 and its variants and has put in place reasonable preventative measures to reduce
the spread of COVID-19 and its variants at its Parish activity (including but not limited to
summer camp). However, even though such standards will be followed and reasonable measures put
into place, St. Peter Parish cannot guarantee that you or your child(ren) will not
become infected while attending the Parish/School activity.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and its variants and that
my child(ren) and I may be exposed to or infected by COVID-19 and its variants by participating in the
parish activity and that such exposure or infection may result in personal injury, illness,
permanent disability, and death.

I understand that the risk of becoming exposed to or infected by
COVID-19 and its variants at St. Peter Parish may result from the actions,
omissions, or negligence of myself and others, including, but not limited to, Parish/School employees,
volunteers, and program participants and their families.

Considering the foregoing, however, I
Parent/Guardian Parent/Guardian First Last
grant permission for my child
Name Name First Last
to participate in this parish activity that may require transportation to a location away from the parish site, notwithstanding the risks associated with the COVID-19 virus and its variants and group activities.

I confirm that there are no necessary changes to the Medical Information Consent form for my child that I previously submitted. If there are any necessary changes, I will complete another Medical Information Consent form.

I further agree on behalf of myself, my child named herein, and my spouse, our heirs, successors, and assigns, to release, indemnify, hold harmless, and defend St. Peter Parish/School and The Roman Catholic Church of the Archdiocese of New Orleans, their members, directors, officers, employees, agents and representatives (“indemnitees”) associated with the event arising from or in connection with the negligent acts or omissions of the indemnitees’ in relation to prevention of the spread of the COVID-19 virus.

I SPECIFICALLY ACKNOWLEDGE AND AGREE THAT I AM AGREEING TO DEFEND, INDEMNIFY AND HOLD HARMLESS THE INDEMNITEES’ FROM THEIR OWN NEGLIGENCE IN REGARD TO THE INDEMNITEES’ NEGLIGENT ACTION AND/OR INACTION IN REGARD TOPROTECTION AGAINST THE COVID-19 VIRUS.
Parent/Guardian 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.
Today's Date Today's Date / MM / DD YYYY
IMAGE RELEASE FORM
I, said Parent/Legal Guardian, I, said Parent/Legal Guardian, First Last
hereby grant permission to St. Peter Parish Catholic Church, its representatives, employees, and assigns the right to take photographs and/or video recordings of me or the minor children listed below over whom I have legal responsibility as parent or guardian.

Further, I hereby grant permission to St. Peter Parish Catholic Church, its representatives, employees, and assigns to use said photographs and/or video recordings in any legal way deemed appropriate by St. Peter Parish Catholic Church, its representatives, employees, and assignees, including but not limited to use in advertisements, publicity, illustrations, and/or Web content. In so doing, I agree to release, indemnify, and hold harmless St. Peter Parish Catholic Church, its representatives, employees, and assigns from any and all claims for damages on behalf of me or the minor children listed below over whom I have legal responsibility as parent or guardian arising from the publication of my/their names, photograph, or likeness on video recordings as described above.
Terms:

If signing on behalf of a minor child or children as parent or legal guardian, please fill in the name of the minor(s) below:
Name Name First Last
Parent/Guardian's 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.
Today's Date Today's Date / MM / DD YYYY
VOLUNTEERS NEEDED - Please check one. All volunteers must have up-to-date Safe Environment certification.

VOLUNTEERS NEEDED - Please check one. All volunteers must have up-to-date Safe Environment certification. willing to serve on ROCK Core Team and assist in planning and chaperoning events willing to chaperone, but unable to assist in planning willing to assist occasionally on an as-needed basis unable to assist
ROCK Registration Payment of $40 includes t-shirt.
If you do not need a T-Shirt this year, fee is $30
Family cap at $100.00

Registration Fees help offset costs for Food, Programming, Insurance, etc.
T-shirt size

T-shirt size Youth Small Youth Medium Youth Large Youth X Large Adult Small Adult Medium Adult Large Adult X Large None
You will be redirected to another site for payment once you hit Submit.

If you are not paying by credit card, you must still hit Submit, then close the window. Check or cash must be turned in to the rectory.

ROCK 2021 -2022 Registration

ROCK 2021 -2022 Registration

Terms:

MEDICAL INFORMATION AND CONSENT FORM

GENERAL INSTRUCTIONS TO PARENTS/GUARDIANS/ADULTS:

SECTION I -- MEDICAL MATTERS -- MANDATORY

SECTION II - EMERGENCY MEDICAL TREATMENT -- MANDATORY

SECTION III - OTHER MEDICAL TREATMENT

SECTION IV - MEDICATIONS SIGN ONLY THOSE OPTIONS THAT ARE APPLICABLE

SECTION V -- MEDICAL INFORMATION

COVID WAIVER:

IMAGE RELEASE FORM

Terms:

ROCK Registration Payment of $40 includes t-shirt. If you do not need a T-Shirt this year, fee is $30 Family cap at $100.00 Registration Fees help offset costs for Food, Programming, Insurance, etc.

You will be redirected to another site for payment once you hit Submit. If you are not paying by credit card, you must still hit Submit, then close the window. Check or cash must be turned in to the rectory.

SECTION IV - MEDICATIONS

SIGN ONLY THOSE OPTIONS THAT ARE APPLICABLE

ROCK Registration Payment of $40 includes t-shirt.
If you do not need a T-Shirt this year, fee is $30
Family cap at $100.00

Registration Fees help offset costs for Food, Programming, Insurance, etc.

You will be redirected to another site for payment once you hit Submit.

If you are not paying by credit card, you must still hit Submit, then close the window. Check or cash must be turned in to the rectory.