Youth Ministry Event Registration Form

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Event Name *

The payment for the National Catholic Youth Conference is only the initial deposit to reserve your spot. Additional payments will be do in July and also in September. Total cost will add up to $950
Participant Name Participant Name * First Last
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 * - ### - ### ####
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. *

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.
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Youth Ministry Event Registration Form

Youth Ministry Event Registration Form

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Youth Ministry Event Registration Form

Youth Ministry Event Registration Form

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