St. Philip EDGE Registration Template

                                      

 

Participant Information
Youth Name
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NickName
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Address
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School
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Grade
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Expected High School Graduation Year
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T-Shirt Size (Adult)
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Youth E-mail
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Youth Phone --
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Date of Birth //
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EXTRACURRICULAR ACTIVITIES
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Sex
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Parent/Guardian Information
Mail should be addressed to:
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Other (Specify)
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FATHER FATHER'S INFORMATION
Name
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Address
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E-mail
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Phone --
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MOTHER MOTHER'S INFORMATION
Name
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Address
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E-mail
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Phone --
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REGISTERED AT:
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PLEASE SPECIFY WHAT PARISH YOU ARE REGISTERED AT:
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EMERGENCY CONTACT INFORMATION
In case of an emergency whom should we contact if we are unable to reach parent/guardian?
Name
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RELATIONSHIP
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Phone --
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Name
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RELATIONSHIP
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Phone --
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HEALTH INFORMATION AND SPECIAL NEEDS
All information will be held in strict confidence
DOCTOR'S NAME
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Phone --
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INSURANCE COMPANY NAME
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MEDICAL INSURANCE ID #
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CARDHOLDERS NAME
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GROUP NUMBER
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PARTICIPANTS ALLERGIES
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PARTICIPANTS CHRONIC MEDICAL PROBLEMS
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PARTICIPANTS OTHER PHYSICAL RESTRICTIONS
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OTHER NOTES
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SACRAMENTS RECEIVED
BAPTISM
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Date and Location
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RECONCILIATION
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Date and Location
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HOLY COMMUNION
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Date and Location
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CONFIRMATION
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Date and Location
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NOTE If you are in need of any Sacraments please contact Katie Tipton at dre@stphilipcc.com
Five Precepts of the Catholic Church
Attend Mass on Sundays.
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Confess your sins at least once a year.
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Receive Communion at least during the Easter Season.
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Keep Holy the Holy Days of Obligation.
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Observe the prescribed days of fasting and abstinence.
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PARENT/GUARDIAN DUTIES
Middle School Parents
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High School Parents
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WE NEED ADULT VOLUNTEERS!
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PHOTOGRAPHY CONSENT
PHOTOGRAPHY CONSENT As parent/guardian, I understand that photos and video (individual and group) will be taken during youth group events, and I give permission for my son's/daughter's picture to be used for printed or online promotional materials
PHOTOGRAPHY CONSENT
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LIABILITY WAIVER
I agree on behalf of myself, my heirs, successors, personal representatives and assign to protect, indemnify, save, and hold harmless the Diocese of Corpus Christi, and St. Philip the Apostle Catholic Church, and their officers, directors, agents employee, or representatives associated with the parish youth program from all damages, claims, suits, expenses and payment on account of or resulting from conditions stated on or resulting from any such injury, death, or damage to property, including resulting from the negligence of the Diocese of Corpus Christi, and parish, and or their officers, directors, and employees arising from or in connection with my attending youth ministry/formation events beginning April 1, 2017 and continuing through May 31, 2018.
LIABILITY WAIVER
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Date //
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