Youth Ministry Event Registration Form
Youth Ministry Event Registration Form
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Payment
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Event Name
*
Camp Hidden Lake; June 17-22, 2019 [WAITING LIST]
40 Days for Life; March 31, 2019, 4:00-6:30 PM
Participant Name
Participant Name
*
First
Last
Parish Name
*
Christ Our King
Saint Benedict
Saint Clare of Assisi
Stella Maris
PROMO CODE (if applicable)
Date of Birth
Date of Birth
*
/
MM
/
DD
YYYY
Youth Email
*
Parent Name
Parent Name
*
First
Last
Parent Email
*
Primary Phone
Primary Phone
*
-
###
-
###
####
Emergency Phone
Emergency Phone
*
-
###
-
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Permission to Participate
*
I grant permission for my son/daughter to participate in this parish youth ministry event, that requires transportation to a location away from the parish site. This activity will take place under the guidance and direction of Parish employees and/or volunteers from Saint Clare of Assisi, Christ Our King, Saint Benedict, and Stella Maris.
Hold Harmless Agreement
*
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 defend Saint Clare of Assisi, Christ Our King, Saint Benedict, and Stella Maris; including all its officers, directors, agents, and the Diocese of Charleston, from any liability for illness, injury or death arising from or in connection with my son's/daughter's attending the above named activity/event.
I give permission for my child, named above, to be photographed at this event and understand that the photographs may be used for publicity, etc...
*
I give permission for my child, named above, to be photographed at this event and understand that the photographs may be used for publicity, etc...
Yes
No
Draw your signature into the box below to grant permission and agree to hold harmless as stated in the paragraphs above.
*
Clear
$
0
Total