STAM Youth Group

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STAM Youth Group

Student's First Name *

Student's Last Name

Sex *

Male

Female

Student Grade *

7th-9th grade

10th-12th grade

Student Age *

Other:

Student's Cell Phone Number

Student's Email

I do hereby give my permission for my child to be contacted via email or text with information pertinent to the STAM youth group. *

I hereby agree.

I do not agree.

Required

Please share any pertinent medical or familial information.

Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent/Guardian Phone Number *

Parent/Guardian Email *

Parishioners at *

St. Mary

St. Anthony

Other:

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Phone Number *

I grant permission for my child(ren) to participate in any event organized by The Archdiocese of Milwaukee, and/or St. Mary/St. Anthony Parish between and including the dates of SEPTEMBER 1, 2023 through AUGUST 31, 2024. If the event is offsite, I also grant permission for my child to be transported by any means of official transportation organized by The Archdiocese of Milwaukee and/or St. Mary/St. Anthony Parish or their representatives.

As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above-named minor (“participant”). I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend St. Mary/St. Anthony Parish its officers, directors, employees and St. Mary/St. Anthony Parish agents, and the Archdiocese of Milwaukee, its employees and agents, chaperones, or representatives associated with the event, from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the parish/school, its officers, directors and agents, and Archdiocese of Milwaukee its employees and agents and chaperones, or representative associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the parish/school or the Archdiocese of Milwaukee.

By completing this form, I agree that if any information submitted in this form changes between myself and St. Mary/St. Anthony Parish, it is my responsibility to notify St. Mary/St. Anthony Parish so they can update the relevant information.

I agree. By checking this box, I am legally agreeing to be bound by the above statement.

Required

Permission for Emergency Medical Treatment and Transport
*

In the event of an emergency, I hereby give permission to transport my child(ren) to a hospital for emergency medical or surgical treatment.

In the event of an emergency, I hereby do not give permission to transport my child(ren) to a hospital for emergency medical or surgical treatment.

Permission for Non-Prescription Medication *

No medication of any type, whether prescription or non-prescription, may be administered to my child(ren) unless the situation is life threatening and emergency treatment is required.

I hereby grant permission for non-prescription medication (i.e. non-aspirin products such as acetaminophen or ibuprofen, throat lozenges, cough syrup) to be given to my child(ren), if deemed appropriate.

Permission for Photographic Image Use: I hereby consent that any still or electronic image and/or audio recording, in which I or my child may appear, may be used by St. Mary/St. Anthony/Archdiocese of Milwaukee. I understand that these materials are being used for promotion of STAM Youth Group and other catechetical events. The images and/or recordings may be used to support recruitment, fundraising, evangelization and other communication efforts. I release the staff and volunteers and I understand and agree that the use of my picture is not an invasion of privacy. Neither I, nor anyone claiming to be speaking on my behalf, will later object to the Archdiocese’s use of this/these photographs. *

Yes, I agree.

No, I do not give permission

Required

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