St. Michael Youth Ministry Registration

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St. Michael Youth Ministry Registration

4 Church St. • Netcong • NJ • 07857

September 2017- July 2018

Know Him † Follow Him † Love Him

First Name: ______Last Name: ______

Date of Birth: ____ / ____ / ______Grade: ______[9-12]

Street Address: ______

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Town/City: ______

Zip Code: ______Student’s Phone Number: (______)______

Student’s Email: ______

School: ______

Siblings in Youth Ministry: ______

***Please indicate with star which email should be used for general information***

Name of Parent/Guardian 1: ______

Last Name: ______

Relationship to Youth: ______

Phone Number: (______)______Cell: (______)______

Work Number: (______)______

Email: ______

Name of Parent/Guardian 2: ______

Last Name: ______

Relationship to Youth: ______

Phone Number: (______)______Cell: (______)______

Work Number: (______)______

Email: ______

Name of Parent/Guardian 3: ______

Last Name: ______

Relationship to Youth: ______

Phone Number: (______)______Cell: (______)______

Work Number: (______)______

Email: ______

Name of Parent/Guardian 4: ______

Last Name: ______

Relationship to Youth: ______

Phone Number: (______)______Cell: (______)______

Work Number: (______)______

Email: ______

*For ALL events and meetings, students under the age of 18 must be picked up from the parish by an adult listed above, or a parent of another registered Youth Ministry student*

Student’s Name Printed: ______

Signature: X______

Parent/Guardian’s Name Printed: ______

Signature: X______

Date: ______

St. Michael Youth Ministry Medical Form:

September 2017- July 2018

Medical Information

Please list any dietary restrictions [if applicable]: ______

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Please list any allergies [if applicable]: ______

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Please list any OTC (over-the-counter) drugs said student may be taking, and for what medical condition(s) [if applicable]:

1.)______; ______

2.)______; ______

3.)______; ______

4.)______; ______

5.)______; ______

If you have listed any medications above, is said student able to self-administer his or her own medication? Yes______No______If no, please contact the Youth Minister or Pastor directly

Physical Conditions that Limit Activity

Please list any chronic or recurring illness(es) and explain in detail [if applicable]: ______

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Has said student had any serious injuries or surgeries in the past year? If so, please explain in detail: ______

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Please identify any other limits, restrictions, or disabilities that could prevent the participant from fully participating in the event or activity (attach additional pages if needed): ______

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Other Accommodations or Special Needs

Please identify any other needs or considerations the participant has that the Youth Minister should be aware of (attach additional pages if needed): ______

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RELEASE OF LIABILITY:

I hereby give permission for my child to participate in upcoming Youth Ministry meetings and events held at the parish. I understand and assume the risks inherent with this event from other parties, but I also understand that all reasonable care and supervision will be exercised to provide for the general well being of my child. I individually and on behalf of my child named above, do hereby release, covenant not to sue, and save harmless: St. Michael Roman Catholic Church, the Diocese of Paterson, and all employees, agents and volunteers for the event, from any and all claims for any and all harm arising to my child as a result of their participation in this event.

I give permission for my child/youth to participate in the event and activities listed above (unless noted) and authorize the adult leaders of St. Michael Roman Catholic Church supervising this event to administer emergency treatment to the above-named participant for any accident or illness and to act in my stead in approving necessary medical care. This authorization shall cover this event and travel to and from this event.

Student’s Name Printed: ______

Signature (if 18+): X______

Parent/Guardian’s Name Printed: ______

Signature: X______

Date: ______

St. Michael Youth Ministry Behavioral Form:

St. Michael's Youth Ministry works to develop young peoplewith a strong relationship with Jesus to be confident in their knowledge of the Catholic faith, and in turn become strong leaders who will share their love for God by evangelizing today's generation

Here at St. Michael Roman Catholic Church, we want to journey with the youth to help them develop a strong relationship with Jesus in an open and safe community. To ensure this for all individuals, the Youth Ministry asks for students to look over the guidelines given below thoroughly. Each student is responsible for his or her own behavior. It is understood that if students break the guidelines, in turn potentially placing harm on others in the community, consequential actions will be taken immediately to re-establish a safe-place for the majority of the participants.

Participation is encouraged immensely ay SMC Youth Ministry. There are many amazing opportunities and events to come with limited participant spaces. For these particular events, we take into account each individual student’s regular mass attendance, YM meeting attendance, participation in various service events, and willingness to volunteer time to the parish. We understand and empathize with students who cannot attend all meetings or events due to school or family related scheduling and will do everything possible to be flexible with anyone who shows a true passion in building a relationship with not only Jesus but also with our parish’s community.

I, ( student’s name ) agree to abide by the following guidelines in all Youth Ministry meetings, events, and retreats;

I will not curse or use inappropriate language: This includes sexual innuendos, violent language, graphic imagery, etc. If you can’t say it in front of Jesus, don’t say it here

I will not drink, show up drunk, or carry alcohol on me: Not only is it illegal, but it also ruins the fun for everyone else participating in events. Alcohol ain’t cool kids

I will not smoke: Trust me, cancer sticks aren’t any more cool. Neither is giving second hand smoke to the SMC community. Just-don’t do it

I will not use, abuse, or distribute drugs: Just really don’t do this one.

I will not carry around a weapon or use violence: Please do not carry around any of the following; gun, knife, switchblade, Swiss army knife, sharp scissors, taser, pepper spray, bombs, lighter, flammable/acidic chemicals, etc. Severe consequences will be met if any potentially harmful weapons are seen on students. No fighting, both physical and oral

I will not film/take nor distribute pornography: We live in the age of technology, where unfortunately sexting is very common, especially in high school. This means nude or inappropriate photos. If you are caught showing, having, or distributing (child-under the age of 18) pornography, we will be forced to take matters to the police or prosecutor

I will dress appropriately at all times: This isn’t just recommended for mass-no see-through shirts, no muscles tanks barely there (aka boys no need to free the nips), no short-shorts that cover half your bum, no crop tops, no see-through leggings, no inappropriate/suggestive language or images on apparel, etc. If you feel weird about a grandparent seeing your outfit and liking it on instagram, then don’t emulate it or wear it here. We will tell you to change into our fabulous array of sweats if necessary

I will keep my hands to myself: This ensures safe and appropriate behavior at all times. We request for no PDA amongst couples. Trust us when we say that no one wants to see it. Also, do not touch the Youth Minister, or the priest, or the teachers, or each other. Please

I will not bully anyone: This includes all forms of bullying; physical, cyber, gossiping, excluding, making fun of, etc. BULLYING WILL NOT BE TAKEN LIGHTLY. There will be different forms of consequences depending on the situation but please take note that it will ALWAYS BE ADDRESSED SEVERELY

I will respect everyone: Treat everyone the way Jesus treats you. Show kindness and love to everyone, because everyone comes from a different walk of life. Try to practice this even when it is most difficult to. Trust that when giving respect, you will earn it back tenfold

A note to parents:If any of these guidelines are broken, depending on the severity, you or an emergency contact will be notified immediately. It is expected that you take responsibility in providing transportation to pick up the student at a moment’s notice; otherwise, the student will be unable to participate in any Youth Ministry activities until proper transport is provided. During special occasions like trips and events, it is understood that you as the parent take full responsibility financially in bringing the student home early if guidelines are broken.

Student’s Name Printed: ______

Signature: X______

Parent/Guardian’s Name Printed: ______

Signature: X______

Date: ______

St. Michael Photo Release Form:

4 Church St. Netcong NJ 07857

stmichaelnetcong.org/youth-ministry

( student’s name ) may be photographed and/or videotaped by St. Michael Roman Catholic Church during activities and/or events. This photo release form gives St. Michael parish permission to photograph your child and release said photos for publication online and/or in print media

I give permission for St. Michael Youth Ministry to photograph and/or videotape my child. I understand that photographs and videotapes may be released to the media and to the public to promote St. Michael Youth Ministry’s programs and/or events. You may modify the permission’s in this release form at any time in writing

Student’s Name Printed: ______

Signature: X______

Parent/Guardian’s Name Printed: ______

Signature: X______

Date: ______