St. Joseph High School Youth Ministry Registration Form

St. Joseph High School Youth Ministry Registration Form

All participants must have this form filled out. Please return to: Sherrie Palmateer spalmateer@ 8420 Belair Rd, Baltimore, MD 21236

Family Name: ________________________________ Parent/Guardian Name: ____________________________ Phone Number: ______________ Email: _______________________________________________________________________ Emergency Contact Name: ___________________________ Phone Number: ______________ Relationship to Student: _________________________________________________________ _____________________________________________________________________________ Teen: _____________________________________ Birthdate: __________________________ Sex: __________________ Grade: ______________ School: ____________________________ Email: _____________________________________ Cell Phone: ________________________ Which Sacraments has your teen received? _________________________________________ Special Needs: medical, learning, or physical disabilities: _______________________________ _____________________________________________________________________________ Insurance Company and Policy #: __________________________________________________ _____________________________________________________________________________ Teen: _____________________________________ Birthdate: __________________________ Sex: __________________ Grade: ______________ School: ____________________________ Email: _____________________________________ Cell Phone: ________________________ Which Sacraments has your teen received? _________________________________________ Special Needs: medical, learning, or physical disabilities: _______________________________ ____________________________________________________________________________ Insurance Company and Policy #: __________________________________________________

Permission and Release

I/We hereby consent to my child/children, __________________________________________ participating in the St. Joseph Youth Ministry activities, those on-site and those off-site. I/We understand that some events will take place away from the parish grounds and that my/our child will be under adult supervision an all reasonable caution will be taken to prevent accidents or injuries. I/We hereby release and indemnify St. Joseph Parish, its staff and volunteers, and the Archdiocese of Baltimore from any and all liability arising from claims of any kind or nature whatsoever from my/our child's/children's participation in these events.

In the event my/our child/children were to become injured, I/we give permission for the supervising adults to seek medical care or treatment for my/our child/children. I/we understand that if my/our child/children does become sick or injured, every effort will be made to contact a parent or guardian. If SJYM cannot reach a parent/guardian, we will contact the emergency contact in our records.

Parent/Guardian Name(s): _______________________________________________________

Signature(s): _______________________________________________ Date: ______________

Photo Release

I/We give permission for the St. Joseph staff to take and use my child's photo/video recordings for use in parish publications including but not limited to the parish website, bulletin, SJYM social media accounts, and other publications.

Parent/Guardian Name (s): ______________________________________________________

Signature(s): _______________________________________________ Date: ______________

Be in the Know

SJYM will use the information on this sheet to add you to our Email list. We will be sending emails at least once a month with updates and events. If you have another email that you would like subscribed to this list, please email Sherrie Palmateer spalmateer@.

Bookmark our website: .

Check it out for the most up to date information about SJYM!

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