Youth Group Registration

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Youth Information
- Last Name REQUIRED Please fill out this field. Please enter valid data.
- First Name REQUIRED Please fill out this field. Please enter valid data.
- Home Address REQUIRED Please fill out this field.
- Birthdate REQUIRED Please fill out this field. Please enter a date.
- Student Cell Phone Maximum 20 characters Please enter a phone number.
- Grade Level REQUIRED Freshman Sophomore Junior Senior Please fill out this field.
- School Attending REQUIRED Please fill out this field. Please enter valid data.
Student Medical / Personal Information
- Medical Matters: I hereby warrant to the best of my knowledge, my child is in good health, and I assume all reasonability for the heath of my child.
  (Of the following statements pertaining to medical matters, sign only those that are applicable).
- Emergency Medical Treatment: In the event of an emergency, I hereby grant 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.
- Emergency Medical Treatment I agree I do not agree
- In the event of an emergency, if you are unable to reach me, contact:
- Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.
- Relationship Please enter valid data.
- Phone Number 1 REQUIRED Please fill out this field. Please enter valid data.
- Other Medical Treatment: In the event it comes to the attention of the parish, its officers, directors and agents, chaperons, or representatives associated with the activity, that my child becomes ill with symptoms such as headache, vomiting, sore throat, fever, diarrhea I will be contated immediately.
- Permission to Contact Due to Medical Concerns I agree I do not agree
- Medication: My child is taking medication at present. My child will bring all such medications necessary, and such medications will be well-labeled. The names of medications and concise directions for seeing that the child takes such medications, including the dosage and frequency of said dosage, are as follows:
- Please list all medication:
- If you do not agree, no medication of any type, whether prescription or non-prescription, may be administered to your child unless the situation is life-threatening and emergency treatment is required.
- Permission to Dispense Prescribed Medication I agree I do not agree
- I hereby grant permission for non-prescription medication (i.e. non-aspirin products such as acetaminophen or ibuprofen, throat lozenges, cough syrup) to be given to my child if deemed appropriate.
- Permission for Non-Prescription Medication to be Administered I agree I do not agree
- Specific Medical Information: The parish will take reasonable care to see that the following information will be held in confidence. Allergic Reactions (medication, foods, plants, insects, etc.)
- Allergic Reactions
- Medically Prescribed Diet
- Physical Limitations
- Other Conditions
- To aid your Youth Ministry team in their task as spiritual guides, and so that we might be sensitive to any personal situations, please indicate any additional information you would us to know such as any major life events (i.e. divorce, death, marriage, birth, etc.) or any other information you think would be valuable to your Ministry team:
- Major Life Events
Parent / Guardian 1 Information
- Last Name REQUIRED Please fill out this field. Please enter valid data.
- First Name REQUIRED Please fill out this field. Please enter valid data.
- Cell Phone Number Maximum 20 characters Please enter a phone number.
- Email Address Please enter an email address.
Parent / Guardian 2 Information
- Last Name REQUIRED Please fill out this field. Please enter valid data.
- First Name REQUIRED Please fill out this field. Please enter valid data.
- Cell Phone Number Maximum 20 characters Please enter a phone number.
- Email Address Please enter an email address.
Photography and Video Policy

Please be aware, that your child’s picture, video or audio may be taken as part of St. Joseph, Colbert Youth Ministry activities. Such activities include recruitment, fund-raising, etc. (Names will not be used in pictures without specific permission.)
Photography and Video Permission I grant permission I DO NOT grant permission
Liability Waiver
- I grant permission for my child to participate in the parish Youth Ministry program events at St. Joseph Parish, Colbert.
  As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor (“participant”). I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend , St. Joseph, Colbert its officers, directors, employees and agents, and the Arch/Diocese of , its employees and agents, chaperons, or representatives associated with the event, from any claim arising from or in connection with my child 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 Diocese of Spokane, 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/diocese.
- Liability Waiver Approval I agree I do no agree

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Youth Group Registration

Photography and Video Policy