Area Youth Ministry Permission Slip

Complete this form to register for Youth Ministry events for the Catholic Area Faith Community of Jesus Our Living Water.
You may now register multiple children using this form!

EACH PARTICIPANT MUST BE REGISTERED BY HIS/HER PARENT OR LEGAL GUARDIAN

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By completing this form online, I understand that I must pay with a credit card in order for my child's registration to be sumitted. *

By completing this form online, I understand that I must pay with a credit card in order for my child's registration to be sumitted. Yes
Parent or Legal Guardian Parent or Legal Guardian * First Last
Parent/Legal Guardian's Phone Parent/Legal Guardian's Phone * - ### - ### ####
Other Phone Other Phone * - ### - ### ####
Email *

We will use this email to contact you with additional information.
Medical Insurance Company *
Policy Number *
Special Concerns of Participant(s) (allergies, medications, etc.) *
If traveling by bus, participant(s) will be meeting the bus at:

If traveling by bus, participant(s) will be meeting the bus at: Our Lady of the Lakes St. Mary
Are you (or your child) a member of one of our AFC's parishes? *

Are you (or your child) a member of one of our AFC's parishes? Yes No
If you aren't a member, name of friend who is. If you aren't a member, name of friend who is. First Last
Number of children/youth you are registering *
EVENT
For which event are you registering your child(ren)?
(Limit of one event per form) *

EVENT
For which event are you registering your child(ren)?
(Limit of one event per form) Mystery Movie ($10)
Participant 1 Participant 1 * First Last
Age on the Date of the Event *
Grade *
Participant 2 Participant 2 * First Last
Age on the Date of the Event *
Grade *
Participant 3 Participant 3 * First Last
Age on the Date of the Event *
Grade *
Participant 4 Participant 4 * First Last
Age on the Date of the Event *
Grade *
Participant 5 Participant 5 * First Last
Age on the Date of the Event *
Grade *
Will you help chaperone this event? *

Will you help chaperone this event? Yes No

We would love to have you join us!
Parent/Legal Guardian Consent

I, the above named parent/legal guardian of the above named participant, request that he/she be permitted to attend the above event with the Catholic Area Faith Community of Jesus Our Living Water. I agree and consent to have the staff members and chaperones, under whose auspices the event is conducted, secure any emergency medical care or treatment that may be necessary for my child during the event. I further assume all responsibility for the decisions, emergency care or treatment made by or for the above named youth. I hereby release and hold harmless the Diocese of New Ulm, the Catholic Area Faith Community of Jesus Our Living Water and its member parishes and their staff, and all volunteer leaders from any and all claims, losses, costs, damages or expenses from any accidents or occurrences causing injury of loss to any person or property during this activity or program.
Parent/guardian agrees to the above conditions *

Parent/guardian agrees to the above conditions Yes
Code of Conduct

Please review with your child.
The following are a few simple rules all participants are expected to follow while participating in this event. I will:
- treat all other persons with respect, not cause any intentional harm (physically, mentally, emotionally, or spiritually) to any other person in any other way;
- respect the property of others in cluding all programs, facilities and property;
- follow all appropriate instructions of all personnel aiding this event, including, but not limited to, chaperones, suport staff, transportation personnel and administration;
- not use, sell or transport tobacco, alcohol or any other controlled illegal substance. If medication is needed, my parent/legal guardian will inform the event coordinator and/or the appropriate staff before the event.
Participant agrees to the above conditions *

Participant agrees to the above conditions Yes
Spam Protection. Please answer this simple question.
If tomorrow is Friday what day is today?
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Area Youth Ministry Permission Slip

Area Youth Ministry Permission Slip

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Parent/Legal Guardian Consent

Code of Conduct

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Area Youth Ministry Permission Slip

Area Youth Ministry Permission Slip

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Parent/Legal Guardian Consent

Code of Conduct

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