Elementary Ministry Registration

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Family Section

Information and contact information about family unit

Mother Name/Guardian *

Mother/Guardian Cell Phone *

Mother/Guardian Email *

Father/Guardian Name *

Father/Guardian Cell Phone Number *

Father/Guardian Email *

Primary Address of Youth *

Primary Phone Number (Preferred contact for Youth ministry related issues) *

Secondary Phone Number *

Preferred email address for Youth ministry communications. *

Please describe any custody related issues (most recent court order should be supplied to youth minister as soon as possible). *

Youth Section

Youth Name *

Date of Birth *

YYYY

School Name *

Grade (2023-2024) *

5th Grade

4th Grade

3rd Grade

2nd Grade

1st Grade

Kindergarten

Pre-K 4

T-shirt size *

This youth has received Baptism, Reconciliation, Eucharist and Confirmation. *

Yes

Medical Information

Please provide pertinent information. Please specify child's name with this information.

Please indicate any medical condition, allergies, or dietary restrictions that we should know about. (Please type N/A if none) *

Please List type, dosage and frequency of current medications (Please type N/A if none apply). *

I permit this child to receive Tylenol if requested (list name below, type N/A if not applicable) *

Please indicate any special needs/mental health needs/diagnoses/accommodation requests that we should know about (Please type N/A if none apply) *

I understand that only adults 21 or older with complete background checks and required Archdiocesan training can participate in a leadership role within the youth ministry. I understand that limited leadership roles are given to adults from the ages of 18 to 20 with complete background checks and required archdiocese in training. *

I have read and understand this statement.

Photo/Video permission: I give my permission for Saint Maria Goretti Youth Ministry to use pictures and videos of my child for the use of advertising and promotional use within the parish and on certain social media sources such as Facebook, Instagram, Youtube and on posters and local parish videos. *

Yes

Transportation Clause: I give permission for approved chaperones, and Youth Minister to drive my child to and from events with the Youth Group. *

Yes

Liability Statement and Medical Permission: Knowing that there will be proper supervision, in case of injury, I will not hold St. Maria Goretti parish or the Archdiocese of Philadelphia or any person or persons connected with them liable. I give permission that, in my absence, my child whose name appears on this form may receive emergency medical care for injuries and situations that should occur while participating in saint maria Goretti youth ministry. *

Yes

I agree that I agree that, in order for my child to participate in youth group, they must abide by rules and regulations put forth by the parish and youth ministry, including any guidelines involving prevention of COVID-19. *

yes

My signature below indicates that the information I have provided is true and complete to the best of my knowledge, and that I have read, understand, and agree to the statements above as indicated by my selected responses and my signature below. *

I have read and understand this statement

Guardian Name *

Guardian Signature *

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms