SAN ANTONIO DE PADUA CHURCH 2016-2017 YOUTH MINISTRY REGISTRATION FORM Are you a registered parishioner: Yes No If no, name of parish where family is registered: Section 1 - Parent/Guardian Information Parent/Guardian (Last, First) Street Address City, State, Zip Religion Home Phone Work Phone Cell Phone Relationship to student: Email Address Parent/Guardian (Last, First) Street Address City, State, Zip Religion Home Phone Work Phone Cell Phone Relationship to student: Email Address Student lives with (check one) Both Parents Mother Father Step Parent Relative Guardian Other (Please explain): Section 2 - Student Information Student Name (Last, First, Middle) Nickname Date of Birth mm/dd/yyyy Gender Check one: M or F Student Cell Phone CI Check one: CII SALT JR. SALT SR. YM Only School Grade in Fall 2016 School Attending T-Shirt size: S/M/L/XL 2XL/3XL Section 3 Other Comments Student Name Date of Baptism mm/dd/yyyy Church of Baptism Mother s Maiden Name Section 4 - Learning Disabilities or Special Needs (Please explain)
SAN ANTONIO DE PADUA CHURCH MINOR PERMISSION, MEDICATION NOTIFICATION & RELEASE FORM Program: Youth Ministry Location: Date: July 1, 2016 June 30, 2017 Time: Various Check one: Confirmation I Confirmation II SALT Youth Ministry Only Participant Information First Name Last Name Gender male female Street Address City, State, Zip Date of Birth: ( mm/dd/yyyy) Parent/Guardian First & Last Name Parent/Guardian First & Last Name Who does minor live with? (First & Last Name) Cell phone number Cell phone number Home phone number Relationship to minor Relationship to minor Student cell phone: T-Shirt Size: S M L XL XXL 3XL Medication Notification: During the above named activity my son/daughter has my permission to take the following: Choose at least one: My son/daughter will be taking a prescription medication. Name of medication:_ Dosage:_ Times per day: My son/daughter will be taking a non-prescription medication. Name of medication:_ Dosage:_ Times per day: My son/daughter will not be bringing any medications, but I authorize, if needed, Youth Ministry leaders to give my child nonprescription, over-the-counter, medications: Notes:/Allergies/Medical Problems/Special Dietary Requirements: Emergency Contact (other than parent/guardian) First Name Last Name Relationship to minor Phone number 1 Home Work Cell Phone number 2 Home Work Cell I, the parent (guardian) of, hereby give my permission for his/her participation in the above named activity. I agree to direct my child to cooperate and conform to directions and instructions of parish, school, or diocesan personnel responsible for this activity. As a condition of my child being allowed to do so, I hereby release and discharge the Diocese of Orange, its constituent organizations, including but not limited to The Roman Catholic Bishop of Orange, a Corporation Sole, and their officers, employees, and volunteers from any and all claims for personal injuries or property damage that she/he may suffer as a result of his/her participation in the activity described above, whether or not such injuries or damage are caused by negligence, active or passive, of any of the entities, individuals named or described above. I agree that in the event my child is injured as a result of his/her participation in the above named activities, including transportation to and from these activities, whether or not cause by negligence, active or passive, of the parish, school, or diocesan programs, or any of its agents or employees, recourse for the payment of any resulting hospital, medical, dental treatment or related costs and expenses will first be had against any accident, hospital, medical or dental insurance, or any available benefit plan of mine or my spouse. I am not aware of any medical condition of my child which would render it in appropriate for him/her to participate in any activity. I, hereby authorize the making of photographs, motion pictures, video tapes, recordings, or other memorializing of said event and my child s participation therein, and the publication and duplication or other use thereof. I, hereby waive any rights to compensation or any right that I otherwise might have to limit or control such making or use. I, hereby give permission to the physician, nurse, dental or licensed care staff selected by the supervisory personnel then present to render medical, dental or other appropriate treatment deemed necessary and appropriate by the physician, nurse, dentist or license care staff. I, hereby give permission to San Antonio Youth Ministry to notify my teen of upcoming events via his/her cell phone and/or email address. I/we will also receive the same notifications sent to my teen. This form expires on July 30, 2017 Both parents/guardians are asked to sign whenever possible or applicable. Parent/Guardian Signature: Parent/Guardian Signature: Date: Date:
Parent / Adult Volunteer Form We need YOUR time, talent and treasure to keep our Youth Ministry program strong. Please complete the form and mark all areas where you can help. Please check one Confirmation 1 Confirmation 2 SALT Youth Ministry Only Teen s Name Parent/Adult Name Occupation Home/Cell Phone Parent/Adult Name Occupation Home/Cell Phone Confirmation Teacher I am interested in becoming a Confirmation teacher or co-teacher. Chaperones I would like to assist the coordinator by helping with social events & community service projects. Driver/Transportation I would like to help by driving (must have copy of insurance declaration page & driver s license); my car capacity is. Hospitality I would like to assist with different events throughout the year. I would like to donate food for different events throughout the year. I would like to donate gift cards as a thank you for teachers or speakers. Fiesta I would like to supply snacks for the kids during their planning and building nights. I would like to help create/build or work the YM concession stand. Retreat Day Support I would like to assist with retreat check-in. I would like to assist at retreat weekend I would like to assist with retreat reunion. Office Administration I would like to come in once a month and help with mailing preparation of newsletters. I would like to provide office supplies stamps, envelopes, pens, folders, craft supplies, etc. I would like to assist with clerical help. Other Other ways I can help, please explain: