Youth Ministry Registration Form 2018-2019

Holy Cross Catholic Church Youth Ministry

2018-2019 Registration

Student Information
Student's Name
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Address
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Student's E-mail
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Cell Phone --
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Home Phone --
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Date of Birth //
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What Social Media do you use?
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What grade will you be in the fall?
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School
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Are you a registered parishioner? If not, where?
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Which sacraments have you received?
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Parents Information
Mom's Name
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Mom's Phone --
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Mom's Work Phone --
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(used in an emergency)
Mom's Email
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Dad's Name
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Dad's Phone --
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Dad's Work Phone --
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(used in an emergency)
Dad's Email
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Do you give permission for the Coordinator of Youth Ministry to contact your teen via social media, phone, text, email?
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Do you wish to receive monthly emails with upcoming Youth Ministry news and events?
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Medical
Insurance Company
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Insurance ID Number
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Allergies
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Special Needs
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Doctor's Name
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Doctor's Phone Number --
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I understand that improper conduct by my child will result in a phone call home and possible dismissal. I give permission to Holy Cross Church staff to seek medical attention for my child if necessary. I give permission for my child’s photo to be taken or posted. Their names will never be attached to the photo. I do not hold the Diocese of Richmond, Holy Cross Church, Holy Cross Church staff or Holy Cross volunteers responsible for any injuries or mishaps which may occur.
Photos are sometimes taken of events for our parish web page, social media accounts, and publicity. Do you give permission to have your child photographed? Names of children are never attached to the photograph.
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Name
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By entering your name, you agree to the stated requirements.
Date //
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Spam Capture
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Volunteering
It is through the support of parent volunteers and family that Youth Ministry can succeed and be kept free of cost. Please consider donating your time and talent over the school year.
Are you VIRTUS certified?
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I am willing to help with
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