Youth Formation Registration

Registration for 2019-2020 Academic Year

Registration Instructions
Register here for all Youth Formation levels: Little Flock (Pre-K 3 - 5th Grade), Edge (6th Grade - 8th Grade) and Life Teen (9th Grade - 12th Grade). If more than 3 children, please use an additional form. For more information about our programs contact via email at: youth@sjbcctx.org
Youth Information
Youth Name Child #1
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Choose Program
Gender
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Date of Birth //
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Grade in School
Please check one of the following:
Sacraments your child HAS received
Was the child Baptized at St. John the Baptist?
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Youth Name Child #2
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Choose Program
Gender
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Date of Birth //
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Grade in School
Please check one of the following:
Sacraments your child HAS received
Was the child Baptized at St. John the Baptist?
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Youth Name Child #3
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Choose Program
Gender
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Date of Birth //
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Grade in School
Please check one of the following:
Sacraments your child HAS received
Was the Child Baptized at St. John the Baptist?
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Parent or Legal Guardian Information
Adult in the Household #1
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Relationship to the Child?
Primary Mailing Address
Primary Phone -- ext
Additional Phone -- ext
Primary E-mail Address
Adult in the Household #2
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Relationship to the Child?
Mailing Address
E-mail Address
Primary Phone --
Consent
Liability Waiver I agree on behalf of myself, my heirs, successors, personal representatives and assign to protect, indemnify, save, and hold harmless the Diocese of Corpus Christi, and St. John the Baptist Catholic Church, and their officers, directors, agents employee, or representative associated with the parish Youth Formation Program from all damages, claims, suits, expenses and payment on account of or resulting from conditions stated on or resulting from any such injury, death or damage to property, including negligence of the Diocese of Corpus Christi, and St. John the Baptist Catholic Church, and or their officers, directors, and employees arising from or in connection with my attending Youth Formation events beginning August 1, 2019 and continuing through August 31, 2020. In the event that any legal action is taken by either party against the other party to enforce any of the terms and conditions of this agreement, it is agreed that the unsuccessful party to such an action shall pay the prevailing party therein all court costs, reasonable attorney fees and expenses incurred by the prevailing party.
Consent
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Today's Date //
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Photo Consent As parent/guardian, I understand that promotional photos/video may be taken during youth events. I give permission for my child's picture/video to be used for promotional reasons to highlight youth events (youth websites/web pages, newsletters, calendars, videos for youth events/youth promotions, etc.).
Consent
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Today's Date //
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HEALTH INFORMATION
ALL INFORMATION WILL BE HELD IN STRICT CONFIDENCE
I hereby warrant to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. Of the following statements pertaining to medical matters, sign only those in accordance with your wishes:
In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor.
In the event of an emergency and you are unable to reach me, contact:
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Relationship
Phone --
Family Doctor
Phone --
Medications My child will bring all such medications, well labeled, that are necessary. Names of medications and concise directions for seeing that the child takes such medications, including dosage and frequency are as follows:
Medication(s), Dosage(s), and Administration:
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Consent
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Today's Date //
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My son/daughter has had an episode of the following:
Does your child have any learning disabilities that may require additional aides or supports so that we may more effectively serve him or her?
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Allergic reactions to the following (foods, dyes, latex, etc.)
Has had a medical surgery within the last six months?
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Still under doctor's care?
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Has a medically prescribed diet?
The following physical limitations?
Immunizations current and up to date?
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You should also be aware of these special medical conditions of my child:
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I fully understand the foregoing statements and sign this Parental/Guardian Medical Consent Waiver knowingly, freely, and willingly.
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Today's Date //
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Document Upload
For Sacramental Preparation Students Please attach a copy of your Baptismal Certificate (dated no later than the previous 6 months). Certificates may be scanned and attached here or you may hand in a copy of the certificate to the office. Certificates are REQUIRED to register for Sacramental Preparation (First Communion & Confirmation) ***Disregard if you submitted one last year***
Upload Documents
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Accepts PDF, JPG, TIF and PNG files.
Payment Information
Registration Fee Please select the fee that applies to your child (ren).  
Quantity Extended

1st CHILD | $60.00

ADDITIONAL CHILD | $35.00

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