St. Francis of Assisi Parish: Youth Ministry Registration 2018-2019
Welcome to St. Francis of Assisi's Youth Ministry!

Whether you are new or returning, our youth ministry team is looking forward to forming a faith building community with you!

To COMPLETELY register, please do the following:

1. Complete this form in its entirety (ONE SUBMISSION PER PARTICIPANT)
2. Make a payment of $90 to the parish office
-Registration will not be complete until payment is received
*Please make checks payable to "St. Francis of Assisi Youth Ministry" with your child's name and which specific ministry (Echo or Ignite) in the "memo" section.

Email address *
Which ministry are you registering for? *
Participant's First Name *
Your answer
Participant's Last Name *
Your answer
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Grade *
School *
Your answer
Participant's Email *
Your answer
Participant's Cell Phone #
Your answer
Allergy/Medical Condition(s) ("N/A" if not applicable) *
Your answer
Father's Name/Guardian #1 *
Your answer
Father's/Guardian #1 Cell Phone # *
Your answer
Mother's Name/Guardian #2 *
Your answer
Mother's/Guardian #2 Cell Phone # *
Your answer
Family Address *
Your answer
Home Phone # *
Your answer
Photo Release *
By checking below, I agree to permit my child to participate in Youth Ministry Programs to be held at St. Francis of Assisi Parish during the 2018-2019 ministry year. I understand that reasonable precautions will be taken to safeguard the health and well-being of my child, and that I will be notified as soon as possible in the event of an emergency. In case of sickness or accident, I authorize and consent to any x-ray exam, anesthetic, medical, dental or treatment and hospital care to be rendered to my child under the general care and advice of any physician, dentist or surgeon licensed to practice in any state. I further understand and agree to be responsible for any such medical, dental and/or hospital expenses incurred. I agree to release St. Francis of Assisi Parish (directors, volunteers, employees and property owners), St. Francis of Assisi’s Youth Ministry, and the Diocese of San Jose of liability for injuries or harm that your child may experience at St. Francis of Assisi’s Youth Ministry Program. *
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