Youth Ministry Registration
Please register your youth for Youth Ministry- this is general information, code of conduct, waiver portion and medical release of the previous permission slips but you only fill it out ONCE per school year! Yay!!

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IMPORTANT INFORMATION!! Sign up genius links will be sent for all field trips. Knowledge of attendance is necessary in order to secure the financial need, transportation, and food for each youth event. If you signed up for an event and later find you can't attend, please notify the Youth Minister. Retreats will continue to have their own registration forms. **PLEASE NOTIFY THE YOUTH MINISTER IF CHANGES HAVE BEEN MADE TO ANY OF THE AREAS BELOW THROUGHOUT THE YEAR**
Students FULL Name(s), age(s) and DOB(s) (all participating) Youngest to oldest *
All participating Student cell phone #(s), youngest to oldest
Grades (2022-2023 school year), youngest to oldest *
Parent FULL Name *
Parent contact information (phone # and email) *
The following are a few rules all participants are expected to follow while participating in youth events: *
I (guardian) grant permission for my child (participant) to participate in the above listed event. I agree on behalf of myself, my child's other parent if known or living (parent), my child named herein or our heirs, successors, and assigns, to hold harmless and defend the Diocese of Little Rock, St. Joseph Catholic Church (its pastor, youth minister, other agents, etc.) or any representatives associated with the scheduled activity unless the parties involved were careless or negligent.   *
I give my son/daughter permission to be a passenger in a protocol-ed adult chaperone's car or ride a bus (as arranged by the St. Joseph Youth Ministry) for the purpose of going to and from the event listed above. I understand all passengers in a private vehicle must wear seat belts, by my agreeing, I agree to hold harmless of neglect any adult chaperone, any staff member, the school, parish or diocese, in case of an accident occurs while on this trip. *
I give permission for my son/daughter to be photographed and to publish the photo in local, diocesan and parish media, both printed and electronic. I also give the youth ministry department permission to contact my son/daughter through phone or electronic media regarding this event. *
I hereby warrant to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.
Of the following statements pertaining to medical matters, sign only accordance to your wishes: in the event of any emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the event of any emergency and you are unable to reach me, contact (name and phone #): *
Medications? Please state participants name with medication. *
I grant permission for medication or any type, whether prescription or nonprescription may be administered by my child unless the situation is life threatening and emergency treatment is required. *
Medical conditions and information: *
Immunizations current and up to date? *
Insurance information: Insurance carrier, Name of insured, insurance ID #, Fathers name, DOB and place of employment, Mothers name, DOB and place of employment. OR state that you do not carry medical insurance at this time. *
Parents: Would you be interested in volunteering at youth events when help is needed (one-two weeks)? *
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