3513 Cimarron Boulevard, Corpus Christi TX 78414 |
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St. Philip Youth Ministry Registration
Participant Information
Youth Name
First Name*
Middle Name
Last Name*
NickName
Address
Street 1*
Street 2
City*
State*
-- select --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
None--International
Zip*
School
Required*
Grade
Required*
Please make a selection
6TH
7TH
8TH
Freshman
Sophmore
Junior
Senior
Expected Graduation Year
Required*
Please make a selection
2016
2017
2018
2019
2020
2021
2022
2023
2024
T-Shirt Size
Required*
Youth E-mail
Required*
Youth Phone
Required*
-
-
--select--
Home
Mobile
Work
Date of Birth
Required*
Month
January
February
March
April
May
June
July
August
September
October
November
December
/
Day
1
2
3
4
5
6
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/
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
-- select --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
None--International
Zip
E-mail
Phone
-
-
--select--
Home
Mobile
Work
MOTHER
MOTHER'S INFORMATION
Name
First Name
Last Name
Address
Street 1
Street 2
City
State
-- select --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
None--International
Zip
E-mail
Phone
-
-
--select--
Home
Mobile
Work
REGISTERED AT:
Required*
Please make a selection
ST PHILIP
ANOTHER PARISH (PLEASE SPECIFY)
NOT REGISTERED AT ANY PARISH
If not St. Philip's please specify which Parish you are registered:
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*
-
-
--select--
Home
Mobile
Work
Name
First Name*
Last Name*
RELATIONSHIP
Required*
Phone
Required*
-
-
--select--
Home
Mobile
Work
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
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 youth@stphilipcc.com.
Five Precepts of the Catholic Church
Attend Mass on Sundays.
Required*
Please make a selection
Yes
Sometimes
No
Confess your sins at least once a year.
Required*
Please make a selection
Yes
Sometimes
No
Receive Communion at least during the Easter Season.
Required*
Please make a selection
Yes
Sometimes
No
Keep Holy the Holy Days of Obligation.
Required*
Please make a selection
Yes
Sometimes
No
Not Sure
Observe the prescribed days of fasting and abstinence.
Required*
Please make a selection
Yes
Sometimes
No
Not Sure
PARENT/GUARDIAN DUTIES
WE NEED ADULT VOLUNTEERS!
Please indicate how you can help!
Set-up for Sunday Youth Ministry Nights
High School CORE TEAM
Kitchen Team
Special Events Volunteer
Spam Capture
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
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 August, 1 2021 and continuing through July 31, 2022.
LIABILITY WAIVER
Required*
I agree
Date
Required*
Month
January
February
March
April
May
June
July
August
September
October
November
December
/
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
It may take a moment for your information to be submitted.