Edge Nights Registration (2019-2020)
The contact info/liability release required for participation in Edge Nights at St. Lawrence
Email address *
Youth's Name (First and Last) *
Your answer
Youth's Shirt Size *
Youth's Grade *
Youth's Age *
Youth's Gender *
Parent/Guardian Name (First and Last) *
Your answer
Home Address *
Your answer
City *
Your answer
Zip *
Your answer
Parent/Guardian Cell *
Your answer
Emergency Contact (Other Than Parents) *
Your answer
Emergency Contact Relationship with Youth *
Your answer
Emergency Contact Phone *
Your answer
Health Insurance Company *
Your answer
Policy Number *
Your answer
Name of Youth's Doctor *
Your answer
Youth's Doctor's Phone *
Your answer
Other medical or otherwise pertinent information
Your answer
I grant permission for my child to participate in the Edge Nights that will take place on-campus at St. Lawrence Catholic Church. I agree on behalf of myself, my heirs assigns, executors, and personal representatives, to hold harmless and defend St Lawrence Catholic Church, the Archdiocese of Mobile, its officers, directors, agents, employees, or representatives associated with the Edge Nights from any and all liability claims, loss, or damage. *
Required
Enter your initials below to certify that you agree with the previously stated liability release *
Your answer
A copy of your responses will be emailed to the address you provided.
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