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YEARLY REGISTRATION

- Ministries

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- Diocese of Stockton
  
  Annual Youth Registration and Promise
  
  CHILD'S 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.
- Date Of Birth REQUIRED Please fill out this field. Please enter a date.
- Home Address 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.
- PARENT'S 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.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Home Address 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.
- I agree to uphold and exemplify positive Catholic values, and I understand that my participation in an Activity requires compliance with rules and regulations regarding my conduct. Specifically, I agree that during my participation in the Activity:
  
  I will not use, bring, or be under the influence of illegal drugs or alcohol;
  
  I will not smoke or use tobacco products;
  
  I will politely obey the requests and directions of the adult leaders;
  
  I will stay with my assigned group or buddy at all times;
  
  I will participate in the approved activity at all times;
  
  I will dress appropriately at all times;
  
  I will be on time to activities and will observe all check in rules;
  
  I will treat adult leaders, other participants, and community members with respect and will not engage in behavior that reflects poorly on me or the group such as: stealing, swearing, fighting, being physically or verbally abusive, being dishonest, damaging property, threatening others, or engaging in disruptive behavior;
  
  I will only use cell phones and other personal devices at appropriate times and places when allowed by adult supervisors;
  
  I will not participate in hazing, teasing, or other similar activities;
  
  I will not engage in inappropriate sexual behavior;
  
  I will not be in the possession of or use firearms, knives, lighters, explosives, or weapons of any kind;
  
  I will not engage in acts of violence; and
  
  I will respect the physical property of the facility used by us and others and will not engage in acts of vandalism.
  
  I agree to abide by these rules and the supervision of adult leaders, and understand that violations will be dealt with in an immediate and appropriate manner. If I should be dismissed from participation in the Activity, I understand that my parents will be contacted to arrange for my immediate transportation home.
- By checking this box I acknowledge and accept that I have read the above information and agree to abide by them.
  
  I also ackowledge that this serves as a digital signture of acceptance.
  
  Child's Agreement Please select this field.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date REQUIRED Please fill out this field. Please enter a date.
- Parental Agreement / Consent
  I/we, the undersigned parent or guardian of the Participant named on this form give permission for my/our child’s participation in the Activity referred to on this form, and:
  
  I/we agree to direct my/our child to cooperate and comply with all reasonable directions and instructions from Children/Youth Ministry staff or adult leaders and Chaperons.
  
  I/we will immediately and at my own cost retrieve my child(ren) from this Activity if my child(ren) does not comply with the Code of Conduct to the satisfaction of the adult leaders.
  
  I/we give permission for my/our child to be transported to and/or from Children/Youth Ministry programs, events, and Activities in vehicles driven by adult leaders selected by the parish Children/Youth Ministry coordinator or Parish Pastor, in accordance with diocesan and/or Parish guidelines.
  
  I/we agree to be responsible for all medical expenses relating to injury of my/our child as a result of his/her participation in any Children/Youth Ministry activity or other Activity, whether or not caused by the negligence of the parish, school, diocesan, or Children/Youth Ministry program employees, Chaperons, agents, or volunteers or other participants.
  
  I/we understand that in the course of participating in Children/Youth Ministry activities or other Activity, my/our child may engage in activity that carries a risk of injury to the body, psyche, or property of themselves and others. Such injuries can be caused by other persons, may be accidental or self-inflicted, or may arise from faulty equipment or facilities, existing conditions of recreational facilities, vehicle accidents while in transport during an activity, or through the activity itself.
  
  I/we are not aware of any medical condition of my child which would render it inappropriate for him/her to participate in any such activity.
  
  I/we, hereby, give permission to the physician or dentist selected by the Activities supervisory personnel then present to render medical or dental treatment deemed necessary and appropriate by the physician or dentist
- Release and Waiver of Liability
  In consideration of my or my child/childrens participation in the activity described, and my consent thereto, and on behalf of my heirs, executors, administrators and next of kin, I hereby release, covenant not to sue and forever discharge the Released Parties (as defined below) of and from all liabilities, claims, actions, damages, costs and expenses of any nature arising out of or related to, or in any way connected with my or my child/childrens participation in the Activity and/or any such related or associated activities, and further agree to indemnify and hold each of the released parties harmless from and against any and all liabilities, claims, actions, damages, costs and expenses including by way of example, but not limited to, all attorneys’ fees, costs of court and the cost and expense of other professionals and disbursements up through and including any appeal. I, for myself, understand that this Release and indemnity includes any claims based on the negligence, action or inaction of any of the Released Parties and covers bodily injury, including, without limitation, death, property damage, and the loss by theft or otherwise, whether suffered by me or my child(ren) during or after such participation. For the purposes hereof, the “RELEASED PARTIES” are:
  The Roman Catholic Bishop of Stockton, a Corporation sole & All Saints University Parish (Turlock, CA)
  
  their respective parent, subsidiary, affiliated or related companies and the officers, directors, employees, agents, representatives, successors, assigns, and volunteers for each of the foregoing entities.
  I am not aware of any medical condition I have which would render it inappropriate for me to participate in any such activity.
  This Release and Waiver shall be governed by the laws of the State of California and any legal action related to or arising out of this Release and Waiver shall be commenced exclusively in the Superior Court in and for San Joaquin County, California, and I specifically waive the right of trial by jury for myself. I certify I am eighteen (18) years of age or older.
  
  I HAVE READ, UNDERSTOOD AND ACCEPT THE CONDITIONS OF THIS RELEASE AND WAIVER FORM, INDEMNITY AND PROMISE NOT TO SUE.
- By checking this box I acknowledge and accept that I have read the above information and agree to it.
  
  I also ackowledge that this serves as a digital signture of acceptance.
  
  Parent/Guardian Agreement Please select this field.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date REQUIRED Please fill out this field. Please enter a date.
Submit

YEARLY REGISTRATION

Parental Agreement / Consent

Release and Waiver of Liability