Youth Phone

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Youth Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Sacraments Received *

Baptism (Catholic)

Baptism (Non-Catholic)

Confirmation (Catholic)

Name Parent/Guardian 1 *

First Name

Last Name

Phone Parent/Guardian 1 *

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Name Parent/Guardian 2

First Name

Last Name

Phone, Parent/Guardian 2

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Primary Residence Phone *

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Name, Emergency Contact *

First Name

Last Name

Phone, Emergency Contact *

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We would love to have your permission to feature photos of your kids on our website, social media, and other communication. *

I hereby grant permission for the above child to be photographed or videotaped and give my permission for his/her picture to be published for the purpose of promoting programs at Saint John the Evangelist Catholic Community and on our web site.

I hereby decline to grant permission for my child to be photographed or videotaped. I have instructed my child to decline being photographed or videotaped at all times and have instructed my child to notify directors, coordinators, catechists, and other volunteers that he/she may not be photographed or videotaped under any circumstances.

I hereby acknowledge that I am the parent or legal guardian of the above child and give him/her my permission to participate in activities planned at the St. John’s Campus and locations within the local area during the scheduled program times and dates. I understand that reasonable precaution will be taken to safeguard the health and safety of the participant and that the designated emergency contact person will be notified as soon as possible in case of emergency. In the event of any sickness or accident I will not hold Saint John the Evangelist, the Archdiocese of Denver, any volunteer, chaperone, or driver responsible. I authorize and consent that emergency treatment be rendered under the general or specific supervision and on the advice of any physician, dentist, or surgeon licensed to practice in the State of Colorado. The undersigned understands and agrees that any medical, dental, or hospital expenses incurred shall be at his/her own expense. The undersigned understands every effort will be made to notify the emergency contact in the event that treatment is necessary. *

I UNDERSTAND AND AGREE TO THE TERMS OF THE ACTIVITY RELEASE