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Junior High SPY

- SPY
  - Registration
  - Upcoming Events
  - What is SPY?
  - Junior High SPY

What is offered for middle school children

For kids in grades 6-8 there will be SPY events held for them once a month.In addition to this there is a bible study held after school roughly every other week.
The maximum number of form submissions has been reached. This form is currently not available.
- Middle School SPY Registration
  
  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 Middle School 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 NICK IF ANY OF THE INFORMATION CHANGES.
- ALL FIELDS ARE REQUIRED. IF A FIELD DOES NOT APPLY, ENTER "NO" OR "NONE."
- Teen Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. 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.
- Parish Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Name of School child attends Please enter valid data.
- Grade
- Parent Guardian Information
  
  Mothers Full Name Please enter valid data.
- Mothers Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Mothers Work Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Ok to text Mom? yes no
- Mothers Email Please enter valid data.
- Fathers Full Name Please enter valid data.
- Fathers Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Fathers Work Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- OK to text Dad? yes no
- Fathers Email Please enter valid data.
- Teen Lives with
- 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
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Relationship to Teen Please enter valid data.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Emergency Contact 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.
- Relationship to Teen Please enter valid data.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- 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 Please enter valid data.
  
  Preferred Physician Please enter valid data.
  
  AT
  
  Physicians Phone Number REQUIRED Please fill out this field. Please enter a phone number.
  
  And our Preferred Dentist Please enter valid data.
  
  At Dentist Phone Number REQUIRED Please fill out this field. Please enter a phone number.
  
  or in the event the designated preferred practioner 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 St. Peter Parish 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 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 Parish 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 Middle 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 Middle 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 Please enter valid data.
- Field Trips/ Activities Consent
  
  I Hereby Give
  
  Name of my Child Please enter valid data.
  
  permission to participate in the field trips and activities of Saint Raphael Parish High School 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 Raphael 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 Raphael Parish High School 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 Please enter valid data.
  
  SAINT PETER PARISH CONSENT AND RELEASE OF LIABILITY FOR USE OF MINOR’S 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 Chid or Children in Middle School SPY Please enter valid data.
  
  “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 Please enter valid data.
  
  Please depress the "Submit" button below to send in your Emergency/Medical Release Form.Thank You!
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