St. Catherine Youth Ministry Registration Form (Form A)

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This information will be used to fill out your child's required documents for participation in any/all Youth Activities for the Year Starting June 1, 2019 extending through May 31 2020. Please fill out and read through all sections of this registration form.

Youth First Name

Youth Last Name

Sex

Birth Date

YYYY

Youth Mobile Phone: (If Applicable) * for Catechist use and FlockNote message delivery

Grade Entering

T-Shirt Size (Adult Sizes)

School Currently attending

Sacraments Needed:

Do you need to receive any Sacraments (Reconciliation, First Communion, Confirmation). For Confirmation, the normal diocesan requirements for Fort Worth is that the candidate be 15, and in their Sophomore year of High School (10th). There is a 2 year required preparation time starting with enrollment in Youth Night at least by 9th grade to be Confirmed by Sophomore year, however, we do have a number of students get Confirmed in Junior and Senior year as well.

First Communion

Reconcilliation

Confirmation

Baptism

Prescriptions and Medications (required)

Please check all that apply, however, be aware some may cancel each other out.

This Child Brings no medication and will bring no medications with him/her.

This child takes medication/s and will self-medicate. The child will bring all such medications necessary, and such medications will be clearly labeled. I understand that the child will be required to turn all medication(s) over to a supervising adult designated to keep medication(s). I further understand that it will be this child’s responsibility to present himself/herself at a location designated for returning medication(s) to this child at the frequencies/times listed below. I understand that the adult to whom this child surrenders the medication has no medical training and this adult will not measure dosages. This child will return the medication(s) to the adult after he/she self-medicates. At the conclusion of the event it will be this child’s responsibility to pick up remaining medication(s), if any, at the self-medication designated location. Names of medications and exact dosage and frequencies/times are as listed below: (you may attach a sheet to this form if you need more space just make sure to sign and date it as well).

This child takes medication but is unable to self-medicate. The child’s parent/guardian will provide and dispense any and all needed medications.

Clear selection

Names of Medications and frequencies/times:

Over-The-Counter Medication Permission

No medication of any type whether prescription or nonprescription may be administered tothis child unless the situation is life-threatening and emergency treatment is required.

Yes

Clear selection

Over-The-Counter Meds Permission

I grant permission for the following nonprescription medication to be given to this child (excluding medication listed below that causes allergic reaction) in the recommended dosage on the medication bottle.

Yes

Non-Aspirin Pain Reliever

Throat Lozenge

Decongestant

Antacid

Antihistamine

Clear selection

Allergic Reactions (meds, foods, plants, bugs, etc.)

Please put NONE if it does not apply.

Any Physical limitations?

Please put NONE if it does not apply.

Has child recently been exposed to contagious disease or condition such as mumps, measles, chicken pox, etc.? If so, date and disease or condition.

Please put NONE if it does not apply.

Please describe any other special medical or non-medical conditions of the child.

Please put NONE if it does not apply.

Do you have another child to register?

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