Triple V Registration
Youth Ministry Registration for High School Teens for the 2021-2022 School Year
Flocknote disclaimer
Emails and cellphone numbers will be automatically entered into Flocknote, so you can be kept up-to-date on what is happening in youth group. You can also always opt-out of flocknote emails by unsubscribing or adjust settings. Teens will NEVER be contacted individually. Church Staff and Volunteers are NOT allowed to contact teens directly. Any communication with teens must involve his/her parent/guardian. For your teen's safety, please let him/her know this.
FAMILY Name *
Are you registered SJN parishioners? *
Teen's Name *
Teen's Date of Birth *
MM
/
DD
/
YYYY
Gender *
Grade level *
Teen's email (optional)
Teen's cell phone (optional)
I have received
Clear selection
Teens's 2 Name
Teen 2's Date of Birth
MM
/
DD
/
YYYY
Teen 2's Gender
Clear selection
Teen 2's Grade level
Teen' 2s email (optional)
Teen 2's cell phone (optional)
I have received
Clear selection
Teen 3's Name
Teen 3's Date of Birth
MM
/
DD
/
YYYY
Teen 3's Gender
Clear selection
Teen 3's Grade
Teen' 3s email (optional)
Teen 3's cell phone (optional)
I have received
Clear selection
Parent Guardian 1's Name *
Relationship *
Occupation *
Religion *
Parent/Guardian's Phone number *
Parent/Guardian's Email Address *
Parent Guardian 2's Name
Relationship
Clear selection
Occupation Parent/Guardian 2
Religion Parent/Guardian 2 *
Parent/Guardian's Phone number
Parent/Guardian's Email Address
Home Address *
Teen(s) live with *
I, as the parent/guardian, grant permission to my child(ren) to participate in youth minstry at St. John Neumann parish. All activities will take place under the guidance and direction of parish employees and/or volunteers from St. John Neumann Parish. Any events or activities not at the parish will require a separate permission. *
I give permission for any photographs of my child at this program to be used on the parish website or with any faith formation public relations. *
As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor(s) (“participant”). I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend St. John Neumann Parish, its officers, directors, employees and agents, and the Archdiocese of Washington, its employees and agents, chaperons, or representatives associated with the event, from any claim arising from or in connection with my child(ren) attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the parish, its officers, directors and agents, and the Archdiocese of Washington, its employees and agents and chaperons, or representative associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the parish/Archdiocese. *
Parent/Guardian's Name for Signature *
Date *
MM
/
DD
/
YYYY
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy