2018-2019
St. Johns Youth Ministry

LIFE TEEN and THE EDGE
Sunday evening, 6:45 – 8;00 pm
(September through April)
For the schedule visit
*****REGISTRATION*****

□ THE EDGE □ EDGE-spanol □ 2019 CONFIRMATION

(7th & 8th gr) (7th & 8th gr Spanish) (10th gr & older)

□ LIFETEEN □ FORMACIÓN De La Fe □ SACRAMENT PREP

(9th – 12thgr.) (9th – 12th gr. Spanish) (Reconciliation and/or Eucharist)

STUDENT NAME AGE BIRTHDATE GENDER

______
SCHOOL NAME:______GRADE 2018-2019______
_
STUDENT EMAIL :______

PARENT NAME MAILING ADDRESS PHONE NUMBER

______Home ______

PARENT EMAI:______EMERGENCY NUMBER______

□Please contact me to serve as an occasional small group leader, helping to facilitate conversations with the young people.

CELL PHONE PARENT: ______CELL PHONE STUDENT: ______

I give my permission to receive occasional I give my permission to receive occasional
text updates via Flocknote □ YES □ NOtext updates via Flocknote □ YES □ NO

SPECIAL NEEDS: MEDICAL, LEARNING DISABILITIES, PHYSICAL DISABILITIES ______

______

CONSENT FOR ONLINE MEDIAIS OPTIONAL. A PARENT HAS THE RIGHT FOR THEIR CHILD’S IMAGE TO NOT BE USED IN ANY ST. JOHN THE EVANGELIST CATHOLIC CHURCH MEDIA.

The undersigned, for valuable consideration received, and for being allowed access to St. John The Evangelist Catholic Church at the Wilde Lake Interfaith Center in Columbia, Maryland ("St. John's") in connection with its activities, or events, expressly assign to St. John's and the Roman Catholic Archbishop of Baltimore, a corporation sole ("Archdiocese of Baltimore"), and to all of their current, former, and future agents and related entities (collectively, "the Church"), all rights, title and interest in, and to, the use of my and my child's image or likeness, including, but not limited to all videotape recordings, photographs, or audio recordings of, or made by, me and/or my child on Church property, during a Church-sponsored event, or for any other Church purpose ("the Property"). The Church shall have, by the signing of this document, the right to assign its rights in the Property, in whole or in part, to any entity, parish, or school within the Archdiocese of Baltimore.

I hereby irrevocably grant the Church the right to use (alone or together with other materials), in whole or in part, the Property, for use in any Church publication, news release, or for any other purpose. Further, I hereby authorize the reproduction, sale, lease, copyright, exhibition, broadcast and/or distribution of the Property without limitation for any lawful purpose whatsoever, and I further waive all rights to any compensation for myand/or my child's appearance or participation. Iunderstand and have been advised that photographs or videotape of participants may be used in publications, websites or other materials produced from time to time by the Church, its Office of Youth and Young Adult Ministry and/or the Archdiocese of Baltimore. Participants' names would not be identified, however, without specific written consent. I further understand that the Church has no control over the use of photographs or film taken by others.

I hereby waive any claims against and release the Church, its current, former, and future religious, employees, volunteers, agents, and successors and assigns from and against any and all claims, demands, actions, causes of actions, suits, costs, expenses, liabilities, and damages whatsoever that I and/or my child may have against the Church in connection with the Property or the lawful use of the Property.I represent that I am eighteen years of age or older, and that I have read and understand the terms of this Assignment, Waiver, and Release.

Signature: ______Date:______

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TUITION FEESChecks payable to: St. John the Evangelist
1 Student in family□$100.00Confirmation □$30.00Mail form & payment to: St. John the Evangelist

2 Students in family□$140.00Sacramental Prep □$20.00 Jan Shaw YM

3 or more students in family□$160.00 1 0431 Twin Rivers Road
Columbia, MD 21044
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NO ONE WILL BE REFUSED CLASSES DUE TO FINANCIAL DIFFICULITY