High School RCY

Why we need this form……

We must have all of this paperwork before your child attends his/her first event.
This information helps us to keep you informed about what’s happening in SPY throughout the year.
Your COMPLETE medical/emergency information helps us to ensure your safety at all of our events and filling out this form will save you and your parents from filling it out over and over again throughout the year!
IMPORTANT: PLEASE NOTIFY ERIN IF ANY OF THE INFORMATION CHANGES.
ALL FIELDS ARE REQUIRED. IF A FIELD DOES NOT APPLY, ENTER "NO" OR "NONE."

Teen info

Number of Children REQUIRED Please fill out this field.
Childs Name 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Parish Please enter valid data.
- Street Adress Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Teens Email Please enter valid data.
- Okay to Email Teen Yes No
- Teens Cell Phone Number Please enter valid data.
- Ok to text Teen Yes No
- T-Shirt Size
- High School Please enter valid data.
- Grade
Childs Name 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Parish Please enter valid data.
- Street Adress Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Teens Email Please enter valid data.
- Okay to Email Teen Yes No
- Teens Cell Phone Number Please enter valid data.
- Ok to text Teen Yes No
- T-Shirt Size
- High School Please enter valid data.
- Grade
Childs Name 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Parish Please enter valid data.
- Street Adress Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Teens Email Please enter valid data.
- Okay to Email Teen Yes No
- Teens Cell Phone Number Please enter valid data.
- Ok to text Teen Yes No
- T-Shirt Size
- High School Please enter valid data.
- Grade

Parent Info

Mothers Full Name Please enter valid data.
Parish Please enter valid data.
Work Phone Please enter valid data.
Cell Phone Please enter valid data.
Ok to text Mom? Yes No

Mothers Email Please enter valid data.

Fathers Full Name Please enter valid data.

Work Phone Please enter valid data.

Cell Phone Please enter valid data.

OK to text Dad? Yes No

Fathers Email Please enter valid data.

Teen Lives With REQUIRED Please fill out this field.

Stepfather, Stepmother, or Guardians name (if appropriate) Please enter valid data.

In case of Emergency and parents/guardian cannot be reached, please list two people to contact

Emergency contact 1

Name REQUIRED Please fill out this field. Please enter valid data.

Relationship to Teen REQUIRED Please fill out this field. Please enter valid data.

Phone REQUIRED Please fill out this field. Please enter valid data.

Emergency contact 2

Name Please enter valid data.

Relationship to Teen Please enter valid data.

Phone Please enter valid data.

Emergency/Medical Release Form

“I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. I understand that it is my responsibility to provide medical insurance for my child, and that it is not be the responsibility of any other person or party, including without limitation the Parish or the Diocese of Cleveland.”

Full Name of Teen REQUIRED Please fill out this field. Please enter valid data.

Authorization for Emergency Medical Treatment
Part 1

In the event reasonable attempts to contact me,

My name Parent/Guardian Please enter valid data.

At

My phone Number Please enter valid data.

Or My Alternate Phone Number Please enter valid data.

Or Other Parent/Guardian (Name) Please enter valid data.

At Other Parent/Guardian Phone Please enter valid data.

Have been unsuccessful, I as the Parent or Legal guardian of

My Teens Name REQUIRED Please fill out this field. Please enter valid data.

do hereby give my consent for St. Peter Parish staff, or an adult representative of the St. Peter Youth Ministry program (1) to seek medical attention and treatment deemed necessary by:

Our Preferred Physician Please enter valid data.

At Physicians Phone Number Please enter valid data.

And our Preferred Dentist Please enter valid data.

At Dentists Phone Number Please enter valid data.

or in the event the designated preferred practitioner is not available, by another licensed physician or dentist; and (2) I give permission to transfer my child to

Our Preferred Hospital Please enter valid data.

or any hospital reasonable accessible. This authorization does not cover major surgery, unless the medical opinion of two other licensed physicians or dentists concur on the necessity for such surgery is obtained prior to the performance of such surgery.

Health Insurance Carrier Please enter valid data.

Name of Policy Holder Please enter valid data.

Policy/Group/Member/Claim Number Please enter valid data.

Please list any medical conditions, allergies, medications, special physical or dietary needs, etc.,that we should be aware of:

I give permission for the SPY staff/volunteers to administer the following otc medication in proper dosages to my teen if necessary: Acetaminophen-Tylenol Ibuprofen-advil Benadryl

Please Verify that all of the information above is correct

“By typing my name below, which shall constitute my electronic signature, I acknowledge that I am the parent or legal guardian of the above named Child(ren) and have the authority to sign this document and act on his/her or their behalf. I agree that my electronic signature is intended to authenticate this writing and to have the same force and effect as my manual signature. As the parent or legal guardian of the student(s) listed above, my signature constitutes my acknowledgement and agreement to all of the foregoing terms.” :

My Name REQUIRED Please fill out this field. Please enter valid data.

Waiver of Liability

“I understand the nature of the activities that will be conducted as part of the Youth Ministry program, which include without limitation any Youth Ministry activities that oocur on St. Peter property or First Saturday Mass and service, [teens seventeen and older or adults could be driving for this activity] and I acknowledge that I have the opportunity to ask questions about the nature of the program and any activities prior to signing. I understand that all activities have certain risks and could result in injury to the children I am enrolling. To the fullest extent allowed by law I, on behalf of myself, my spouse, and my minor child or children, assume all risks in connection with my child’s or children’s participation, and release and agree to hold harmless and indemnify Saint Peter Parish, the Diocese of Cleveland, the Bishop of the Diocese of Cleveland, and all of their employees, agents, representatives, and volunteers, the High School Youth Ministry program or any affiliated group for, from, and against any and all causes of action, claims, liabilities, or damages arising out of or relating to the activities of the programs of Saint Peter Parish High School Youth Ministry, whether foreseen or unforeseen, and regardless of cause, including without limitation with respect to the negligence of any person.
- “By typing my name below, which shall constitute my electronic signature, I acknowledge that I am the parent or legal guardian of the above named Child(ren) and have the authority to sign this document and act on his/her or their behalf. I agree that my electronic signature is intended to authenticate this writing and to have the same force and effect as my manual signature. As the parent or legal guardian of the student(s) listed above, my signature constitutes my acknowledgement and agreement to all of the foregoing terms.” :
My Name REQUIRED Please fill out this field. Please enter valid data.

Field Trips/ Activities Consent

I hereby Give (Name of My Child) REQUIRED Please fill out this field. Please enter valid data.

permission to participate in the field trips and activities of Saint Peter Parish Youth Ministry on or off the premises. I understand that all activities have certain risks and could result in injury to my child. I understand and agree that my child will be expected to adhere to any and all safety precautions directed by the Youth Ministry leaders.
I understand and agree that my child must follow all the instructions given by the Youth Ministers, as well as any and all rules and regulations of Saint Peter Parish High School Youth Ministry, and that failure to follow such instructions or rules may result in my being contacted to pick up my child from the activity.
I agree that my child may be transported in vehicles arranged by Saint Peter Parish Youth Ministry, which are insured vehicles driven by licensed drivers. I understand that travel to a location off Parish premises of any kind, whether by vehicle, foot, or any other means, constitutes a field trip. I agree that my child may participate in any and all trips that are offered as long as he/she is in attendance. I understand that it is my responsibility to ascertain my child’s physical fitness to participate in any and all field trips of this program.
“By typing my name below, which shall constitute my electronic signature, I acknowledge that I am the parent or legal guardian of the above named Child(ren) and have the authority to sign this document and act on his/her or their behalf. I agree that my electronic signature is intended to authenticate this writing and to have the same force and effect as my manual signature. As the parent or legal guardian of the student(s) listed above, my signature constitutes my acknowledgement and agreement to all of the foregoing terms.” :

My Name REQUIRED Please fill out this field. Please enter valid data.

St. Peter Parish Consent and Release of Liability for use of Minors Likeness and other Information

I (We) the parent(s) and/or guardian(s) hereby grant consent for Saint Peter (“Parish”), and/or its agents to record (in writing or otherwise), photograph, audiotape, or videotape the name, image, likeness, spoken words, student work, and/or performance of my minor child/children listed below, in any form, and to display, release, exhibit, publish, or distribute the same, or any part thereof, for the purpose of and in connection with any material that may be created by or on behalf of the Parish (including the Parish’s school) including, without limitation, Parish bulletin boards, school yearbooks, the Parish’s or Parish’s school website, print and electronic media; Parish and Parish school marketing, public relations and communications materials and/or presentations, and such other uses as may not be contemplated herein, without further notice or compensation as follows:
I further understand that by entering into this informed consent and release, and by granting permission as stated herein, I hereby release the Parish, the Parish School, the Diocese of Cleveland, and their respective officers, directors, agents and/or employees from and against any and all liability, loss, damage, costs, claims, and/or causes of action arising out of or related to the above items to which I have consented.
I further understand that the Parish and its respective officers, directors, agents and/or employees have no control over use of photographs, videotapes, audiotapes, or other records made by others and/or outside the scope of this consent and release.
Finally, in signing below I acknowledge that all recordings, audiotape, videotape, photographic proofs, photographic negatives, positives, and prints shall constitute the property of the Parish.
- Name of Minor Student(s) in SPY:
- “By typing my name below, which shall constitute my electronic signature, I acknowledge that I am the parent or legal guardian of the above named Child(ren) and have the authority to sign this document and act on his/her or their behalf. I agree that my electronic signature is intended to authenticate this writing and to have the same force and effect as my manual signature. As the parent or legal guardian of the student(s) listed above, my signature constitutes my acknowledgement and agreement to all of the foregoing terms.” :

My Name REQUIRED Please fill out this field. Please enter valid data.

PLEASE HIT SUBMIT AND THANK YOU FOR REGISTERING WITH US!

High School RCY

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Welcome to the Ridgeville Catholic Youth Group!

Meetings for the High School Youth Group are suspended for now. Please watch the website and bulletin for future information.

High School Youth Ministry Registration & Permission

For more information: