Youth Group Sign Up 2023-24
Please fill out Youth Group Sign up for 2023-24 year
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Email *
Name of Participant
Age
School
emergency contact and phone number
Any medical concerns or dietary restrictions
Parental Permission for electronic contact
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If Yes, please list students email 
If yes, please list students cell number
Permission for posting pictures and videos
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Liability Waiver:                                                                        By inputting my initials below, I hereby agree to indemnify and hold harmless St. Katharine of Siena, the Archdiocese of Philadelphia and its officers, employees, and volunteer staff from any liability. I accept responsibility for any medical expenses as a result of any such injury sustained.
Medical Release: By inputting my initials below, I as a parent and/or guardian, I do herewith authorize the treatment by a qualified and licensed medical doctor in the event of a medical emergency which, in the opinion of the attending physician, may endanger his or her life, cause disfigurement, physical impairment or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach me. This release is intended for Nov 9-10, 2018. This release form is completed and signed of my own free will with the sole purpose of authorizing medical treatment under emergency circumstances in my absence.
Health Insurance Information/ Please provide name of policy holder, name of insurance co & policy number
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