Registering for *

Middle School Youth Group (Grades 7-8)

High School Youth Group (Grades 9-12)

Birthdate *

MM

DD

YYYY

*

Male

Female

Mother's Cell

(###)

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Father's Cell

(###)

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Youth's Cell Phone

(###)

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I would like to be included on all youth communication (email and messages)

Yes Please include me on all messages and emails

Does your child have a medical condition, food allergies, or behavioral problems? *

Please indicate below any special circumstances regarding your child or family. If allergy is potentially life threatening, please meet with the Director to discuss.

Yes

No

In the event that a parent/guardian cannot be reached, I hereby give my consent to St. Charles Borromeo Catholic Church to contact the physician listed above, and, if necessary, transport my child to a clinic or hospital *

I agree

I do not agree

I hereby give St. Charles Borromeo Catholic Church permission to publish pictures of my child on the parish website, social media, and/or parish publications. (Please note: No names will be included with pictures). *

I agree

I do not agree

I am interested in helping as a small group facilitator for Youth Group *

Yes, I understand that to volunteer I need to complete the Safe Environment Training provided by the Archdiocese of Omaha

No

Maybe, but I would like more information first

I have had the opportunity to review the St. Charles Borromeo Youth Handbook and agree to abide by the policies of the Handbook. * *

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