Gretna St Patrick Youth Group Registration
Registration for 2020-2021 School Year
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Home Phone Number (if applicable)
Family Last Name *
Mother's Name *
Mother's Phone *
Mother's Email *
Mother Willing to Volunteer (If yes, please go to https://stpatricksgretna.org and complete the Adult Volunteer form.) *
Required
Father's Name *
Father's Phone *
Father's Email *
Father Willing to Volunteer (If yes, please go to https://stpatricksgretna.org and complete the Adult Volunteer form.) *
Required
Emergency Contact Other than Parent(s) *
Relationship of Emergency Contact to Student(s): *
Emergency Contact Phone *
Home Street Address *
City *
State *
Zip *
Subdivision
Additional Home Street Address (if applicable)
City
State
Zip
Subdivision
Registered Member of St Patrick Parish: *
Required
Student #1 Name *
Student #1 Phone Number
Student #1 Email Address *
Student #1 Gender *
Please list any allergies, medical conditions, or learning/behavioral issues we should be aware of.
Student #1 Class Fall 2020 *
Student #2 Name
Student #2 Phone Number
Student #2 Email Address
Student #2 Gender
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Please list any allergies, medical conditions, or learning/behavioral issues we should be aware of.
Student #2 Class Fall 2020
Clear selection
Student #3 Name
Student #3 Phone Number
Student #3 Email Address
Student #3 Gender
Clear selection
Please list any allergies, medical conditions, or learning/behavioral issues we should be aware of.
Student #3 Class Fall 2020
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Select how you will send $30 payment per student: *
I/we grant permission for my/our child(ren), to participate in all parish events that require transportation to a location away from the parish site. These activities will take place under the guidance and direction of parish employees and/or volunteers from St. Patrick’s Catholic Church of Gretna. 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. Patrick’s Catholic Church of Gretna, its officers, directors, employees and agents, and the Archdiocese of Omaha, its employees and agents, chaperons, or representatives associated with the event, from any claim arising from or in connection with my child attending the events 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, its officers, directors and agents, and the Archdiocese of Omaha, its employees and agents and chaperons, 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/diocese. *
Required
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