St. Philip Youth Ministry Registration

Participant Information

Youth Name

First Name*

Middle Name

Last Name*

NickName

Address

Street 1*

Street 2

City*

State*

Zip*

School

Required*

Grade

Required*

Expected Graduation Year

Required*

T-Shirt Size

Required*

Youth E-mail

Required*

Youth Phone

Required* --

Date of Birth

Required* //

EXTRACURRICULAR ACTIVITIES

Sex
Required*

	Female
	Male

Parent/Guardian Information

Mail should be addressed to:
Required*

	Parents
	Mother
	Father
	Other (Specify)

Other (Specify)

FATHER

FATHER'S INFORMATION

Name

First Name

Last Name

Address

Street 1

Street 2

City

State

Zip

E-mail

Phone

MOTHER

MOTHER'S INFORMATION

Name

First Name

Last Name

Address

Street 1

Street 2

City

State

Zip

E-mail

Phone

REGISTERED AT:

Required*

PLEASE SPECIFY WHAT PARISH YOU ARE REGISTERED AT:

EMERGENCY CONTACT INFORMATION

In case of an emergency whom should we contact if we are unable to reach parent/guardian?

Name

First Name*

Last Name*

RELATIONSHIP

Required*

Phone

Required* --

Name

First Name*

Last Name*

RELATIONSHIP

Required*

Phone

Required* --

HEALTH INFORMATION AND SPECIAL NEEDS

	All information will be held in strict confidence
DOCTOR'S NAME	Required*
Phone	Required* --
INSURANCE COMPANY NAME	Required*
MEDICAL INSURANCE ID #	Required*
CARDHOLDERS NAME	Required*
GROUP NUMBER	Required*
PARTICIPANTS ALLERGIES	IF ANY, INCLUDING MEDICATIONS AND FOODS*
PARTICIPANTS CHRONIC MEDICAL PROBLEMS	(e.g. diabetes, epilepsy)*
PARTICIPANTS OTHER PHYSICAL RESTRICTIONS	IF ANY*
OTHER NOTES

SACRAMENTS RECEIVED

BAPTISM
Required*

	YES
	NO

Date and Location

HOLY COMMUNION
Required*

	YES
	NO

Date and Location

CONFIRMATION
Required*

	YES
	NO

Date and Location

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.	Required*
Confess your sins at least once a year.	Required*
Receive Communion at least during the Easter Season.	Required*
Keep Holy the Holy Days of Obligation.	Required*
Observe the prescribed days of fasting and abstinence.	Required*

PARENT/GUARDIAN DUTIES

Middle School Parents

Please indicate your preference of month that is best for us to call on you to help prepare meals one Thursday of your preferred month. For the 2019/2020 School Year.

High School Parents

Please indicate your volunteer preference for the 2019/2020 School Year: Small Groups, Retreats, Encounter Saturdays, Cooking, Social Events.

WE NEED ADULT VOLUNTEERS!

Please indicate how you can help!

	Set-up for Sunday/Thursday Youth Ministry Nights
	Middle School CORE TEAM
	High School CORE TEAM

	Kitchen Team
	Special Events Volunteer

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
Required*

	I AGREE
	I DISAGREE

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 June, 1 2019 and continuing through June 1, 2020.

LIABILITY WAIVER
Required*

I agree

Date

Required* //

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