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Parish Registration Form

- Youth Ministry

Open for grades 7th - 12th (High School Students)
The maximum number of form submissions has been reached. This form is currently not available.
- Family information
- Mother/Guardian Name
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Email REQUIRED Please fill out this field. Please enter an email address.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Father/Guardian Name
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Emergency Contact
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Relationship to youth REQUIRED Please fill out this field. Please enter valid data.
- Youth Information
- Number of additional youth registering REQUIRED Please fill out this field. Please enter valid data.
- Youth 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Please fill out this field.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Phone Number Maximum 20 characters Please enter a phone number.
- Email Please enter an email address.
- Sacraments Needed REQUIRED Baptism First Holy Communion Confirmation None Please fill out this field.
- Medical Concerns or Allergies
- Flocknote: St. Mary's utilizes Flocknote to keep parishioners up to date with news and events within the parish. St. Mary's Youth Ministry groups allow parents to be informed about events, changes and cancelations, registration deadlines, and any other info that may pertain to the Youth Ministry Program. Please add "[email protected]" to your e-mail contact list to keep e-mails form going to spam/junk mail.
  
  Consent:
  The Diocese of Amarillo, their officers, directors, and agents from any liability for illness, injury or death arising from or in connection with my son's/daughter's attending the youth ministry program/events. I agree to compensate the above-named parish, Diocese, their officers, directors and agents, and/or representatives associated with the event for reasonable attorney's fees and expenses arising in connection therewith.
  I/We likewise release from liability any person(s), airline, bus company, or other transportation service, transporting my child, in a privately owned and/or leased vehicle, to and from any activities connected with the above named event(s), with the exception of gross negligence due either fully, or in part, to mechanical failure and/or operator error.
  Additionally, I/We give permission for my/our son/daughter/guardianship to be videoed, photographed during activities associated with the youth ministry program/events. I/we understand that said photos/videos may be used for future publicity within the parish, Diocese, and or Catholic Church.
  As a participant, I agree and covenant to follow all rules of conduct established for participation in this program/events. I understand that any serious infraction of these rules will result in my parent/guardian being notified and being asked to leave the Diocesan Activity at my or own expense. Basic rules/expectations include, but are not limited to, the following:
  
  Respect for all adults leaders, peers, and all property; NO illegal drugs, alcohol, underage smoking, firearms, explosives, or illegal substances; No inappropriate physical/sexual activity; Appropriate attire is to be worn at all times. Other guidelines may be set forth accordingly by adult chaperones present for the program/event(s). Bags are subject to search at the discretion of the youth minister and/or staff and consent is given by the youth and parents/guardians for the search.
  To the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. In the event of an emergency, I give permission to transport my child to a hospital for emergency treatment. I wish to be advised prior to any further treatment by the hospital or doctor.
  
  I hereby grant permission for non-prescription medicine (such as cough drops, cough syrup, Tylenol, etc.) to be given to my child as necessary. I understand that aspirin will not be given to my child.
  Expectations
  ALL YOUTH MINISTRY MEMBERS ARE EXPECTED TO:
  
  Be responsible for their guests
  
  Remain with the group at all times.
  
  Be respectful to all in attendance
  
  Adhere to dress code requirements
  
  Adhere to code of conduct
- My parent/guardian and I understand the guidelines above and realize, if violated, actions deemed necessary by the Youth Coordinator will be taken which may include parental contact.
- I Agree Please select this field.
Submit

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St. Mary's Catholic Church

Wheeler, TX

Parish Registration Form