Middle School 25-26 Registration

Youth Information

Info given for youth or parents may be provided to staff and cleared adult volunteers for ministry communications. We may also communicate using social media, text messaging, email, and Flocknote.

Youth Name

Nickname

Birthdate

Gender

Female Male

Grade

6th 7th 8th

School Name

School District

Cell Phone

Permission to text

Yes No Youth does not have a cell phone.

Address

Race/Ethnicity

T-Shirt size

Faith Formation - BLAZE

BLAZE, Middle School Formation, will be offered at the following time:
• Sundays, 3:15-4:45pm

FRIEND Request, FIRST & LAST name

Youth Sacrament History

Please check all the sacraments which your child HAS received:

Baptism (Catholic or other Christian Denomination) 1st Reconciliation (Confession, Penance) 1st Communion Confirmation None of the above

The Roman Catholic Church recognizes baptism from many other non-Catholic Christian communities. If the registering participant was baptized in a non-Catholic Christian community, which one was it?

Confirmation Preparation

Eighth Graders who participated in faith formation in 7th grade are eligible to participate in the 2nd year of preparation for the sacrament of confirmation. Eighth graders who did NOT participate in 7th grade may participate in the 1st year of confirmation preparation.

Please select the option which applies to the teen you are registering.

Year 1 - (7th graders who are baptized + received First Communion) Did not participate last year. I understand that my child and I are expected to attend the Year 1 Confirmation Preparation Meeting in August 2024 Year 2 - Participated at OLA last year. Year 2 - Participated at a different parish last year. (A staff member will contact you.) I'm not sure. Not applicable.

Parent/Guardian 1 Info

P1 First Name

P1 Last Name

P1 Email

This address will receive a confirmation email

P1 Cell Phone

P1 Permission to text?

Yes No

P1 Address (if NOT the same as the youth)

P1 BirthDate

P1 Race/Ethnicity

P1 Religion (if NOT Roman Catholic)

Parent/Guardian 1 Volunteer

If you are not a cleared adult, please contact our Safe Environment Office at safety@ourladyofangels.com to start the process.

Please check all that you are interested in volunteering for:

MS Catechist/Core Team Substitute Catechist (ALL cleared adult parents will be on the sub list.) Hospitality -helping with set up and snacks for 3:15 Chaperone events Other None

If you selected “MS Catechist” above, please give details about your preferences: WITH or WITHOUT your child, GRADE preference (if you have one), work with another SPECIFIC volunteer (if you have one)

Parent/Guardian 2 or other Emergency Contact

P2 First Name

P2 Last Name

P2 Email

P2 Cell Phone

P2 Permission to text? Yes No

P2 Address (if NOT the same as the youth)

P2 BirthDate

P2 Race/Ethnicity

P2 Religion (if NOT Roman Catholic)

Parent/Guardian 2 Volunteer

If you are not a cleared adult, please contact our Safe Environment Office at safety@ourladyofangels.com to start the process.

Please check all that you are interested in volunteering for: MS Catechist Substitute Catechist (ALL cleared adult parents will be on the sub list.) Hospitality - Assist with or lead serving of meals on Sundays 6-6:30pm Chaperone events Other None

If you selected “Middle School Catechist” above, please give details about your preferences: WITH or WITHOUT your child, GRADE preference (if youhave one), work with another SPECIFIC volunteer (if you have one)

Medical Information

Primary Physician Name

Primary Physician Phone

DRUG & NON-FOOD allergies (describe allergy, reactions, seriousness & management).

FOOD allergies & dietary restrictions (describe allergy, reactions, seriousness & management)

Medical conditions, physical restrictions, learning challenges, behavioral conditions or social concerns

Medications

Medication Administration

This child takes no medication and will bring no medication with him/her. This child takes medication & will self-medicate. The child will bring all medications clearly labeled. I understand that all medication must be turned over to a supervising adult. This child takes medication but is unable to self-medicate. The child’s parent/guardian/conservator will provide and dispense any and all needed medications.

Names of medications and exact dosage and frequencies/times:

No medication of any type whether prescription or nonprescription may be administered to this child unless the situation is life-threatening and emergency treatment is required.

True False - I give consent for over-the-counter medications EXCEPT for those listed in the next box.

Our Lady of Angels may provide non-prescription over-the-counter medications to the participant as needed, EXCEPT the following:

Note about Medications: All Medical Information will be maintained in a strictly confidential manner. Should your child have an Emergency Injection Device (Epi-Pen), Diabetic Condition, Asthmatics with a rescue inhaler, or other special medical conditions, a separate sheet will need to be attached with a clear description as to the nature of the medical condition and any medication. This is important for situations where the youth is not able to self-administer these treatments and to communicate with Emergency Personnel. Ministry leaders, volunteers, and other parish staff are NOT trained to administer these types of emergency medications.

Insurance Information

Insurance Company

Insurance Phone Number

Insurance Policy Number & ID

Name of Insurance Holder

Relationship of Holder to Teen

Consent to Participate and Liability Release

In consideration for allowing Youth to participate in youth activities and functions, in-person and/or via virtual meeting, I/we, the parent(s)/guardian(s)/conservator(s) of Youth, grant permission for Youth to travel to and participate in youth events and activities. I/we assume all risks and hazards incidental to Youth's participation in the Event, including transportation to and from the Event. In consideration for allowing Youth to participate in the event listed above, and on behalf of myself/ourselves and Youth's parents, legal guardians, siblings, heirs, assigns, and personal representatives, I/we hereby release and agree to fully and unconditionally protect, indemnify, and defend the Parish, the Roman Catholic Diocese of Dallas, and their respective officers, agents, and employees, (collectively, “Indemnitees”) and hold each Indemnitee harmless from and against any and all costs, expenses, attorney’s fees, claims damages, demands, suits, judgments, losses, or liability for injuries to property, injuries to persons (including Youth) and from any other costs, expenses, attorney fees, claims, suits judgments, losses, or liabilities of any and every nature whatsoever arising in any manner, directly or indirectly, out of, in connection with, in the course of, or incidental to Youth's participation in youth events and activities, REGARDLESS OF CAUSE OR OF THE JOINT, COMPARATIVE OR CONCURRENT NEGLIGENCE OF THE INDEMNITEES. In the event any legal action is taken by either party against the other party to enforce any of the terms and conditions of this release, it is agreed that the unsuccessful party to such action shall pay to the prevailing party therein all reasonable court costs, attorneys’ fees, and expenses incurred by the prevailing party.

I have read this consent & liability release, & I understand & voluntarily agree to its provisions.

Authorization of Consent to Treat a Minor

I/We, are the parent(s) &/or guardians of the child listed above, a minor, and as such do hereby authorize Our Lady of Angels, its youth ministry leaders, employees, contractors and volunteers as agent(s) for the undersigned to consent to any x-ray examination, anesthetic, medical, dental, or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered under the general or specific supervision of any physician or surgeon licensed under the laws of the jurisdiction where such diagnosis or treatment may be given, whether such diagnosis or treatment is rendered at the office of said physician, at a hospital, or at any other location. It is understood that this authorization is given in advance of any specific treatment or diagnosis, but is given to provide authority and power of treatment, or hospital care which the aforementioned physician in the exercise of best judgment may deem advisable. This authorization is given pursuant to the provisions of Chapter 32 of the Texas Family Code. This authorization shall remain effective throughout the specific event dates listed on this form. In consideration of acceptance of this authorization, but without any time limitation and without any future right of revocation, I/we hereby release, defend and hold harmless the Parish and Roman Catholic Diocese of Dallas (Diocese), their officers, directors, agents, employees, volunteers, youth ministry leaders, and contractors from all claims, liabilities and loss in any way arising out of or in connection with or relating to such treatment and treatment decisions.

I have read this consent to treat statement, & I understand & voluntarily agree to its provisions.

Audio/Visual Recording & Photography Consent

On occasion, video recordings, audio recordings, photographic slides, and photographs are taken of children and youth during church and diocesan sponsored activities. These are utilized in newsletters, websites, event promotion, advertisements and other printed media. As the State of Texas does not prevent audio or video recording or the photographing of children/youth for good and valuable consideration, I hereby grant to Our Lady of Angels Catholic Church the irrevocable and unrestricted right to make, use and/or publish any and all photographs, videos, and other images of me/my minor child or images in which Student may be included, now existing or hereafter made, in any case, with or without identifying Student for editorial, advertising, news, or any other purpose and in any manner and medium; to alter the same without restriction; and to copyright the same. On behalf of myself and/or my child, I specifically waive all rights to privacy and confidentiality with respect to name, likeness, voice, photographs, images, video recordings, audio recordings and identifying information. I hereby release and agree to fully and unconditionally protect, indemnify, and defend Our Lady of Angels, the Roman Catholic Diocese of Dallas, and their respective officers, agents, and employees, (collectively, “Indemnitees”) and hold each Indemnitee harmless from and against any and all costs, expenses, attorney’s fees, claims damages, demands, suits, judgments, losses, or liability for injuries to property, injuries to persons (including Student) and from any other costs, expenses, attorney fees, claims, suits judgments, losses, or liabilities of any and every nature whatsoever arising in any manner, directly or indirectly, out of, in connection with, in the course of, or incidental to the use or publication of any photographs, videos, or other images of Student, REGARDLESS OF CAUSE OR OF THE JOINT, COMPARATIVE, OR CONCURRENT NEGLIGENCE OF THE INDEMNITEES. If you wish to opt out the participating child or discuss any part of this media release, please email a youth ministry staff member.

I have read this consent for Media Release, & I understand and voluntarily agree to its provisions.

Consent for Video Conferencing

I, the parent/guardian of the child named above, give consent for my child to participate in Our Lady of Angels video conferencing for the purpose of participating in faith formation and youth ministry activities. My child’s name, image, speech, typed content and segments of video may be transmitted during video conferences. I understand that these video calls may be recorded for Safe Environment purposes. The information shared with Our Lady of Angels staff and volunteers is meant solely for youth ministry use. Any use outside of Our Lady of Angels’ ministry such as sharing video content to a third-party website, personal website or social media account is strictly prohibited.

I have read this consent for video conferencing, & I understand & voluntarily agree to its provisions.

Youth Ministry Code of Conduct

Treat other participants, leaders, staff and residents with respect and understand that all adult leaders have the authority to discipline me. Follow the schedule and guidelines given to me. Alcohol, weapons, fireworks, tobacco products of any kind, illegal drugs and profane or abusive language are NOT ALLOWED on any part of this activity. (Prescription drugs must be dispensed by an adult leader.) Represent Our Lady of Angels Catholic Church and agree to behave in a Christian and positive manner at all times. Dress appropriately during all activities. Sexual indiscretion (including PDA’s-public displays of affection) is prohibited at all times and in all cases. No participant is allowed to leave without an adult’s permission. Stay with my assigned group at all times. Arrive no earlier than 15 minutes prior to scheduled start time of event and be picked up no later than 15 minutes after scheduled event conclusion. I, and my parents, will be financially responsible for any damage I do to others’ property, facilities or vehicles. If I choose to violate any part of this “code of conduct”, I may have my parents notified by phone and my parents may be asked to pick me up, immediately.

I have read this Code of Conduct, agree to its provisions, & will review it with my child.

Civil Authority Acknowledgement

I confirm I am a legal parent/guardian/conservator and have the civil authority to arrange sacramental preparation and spiritual formation for the minor(s) named on this form.

Electronic Signature for Agreements

Name of Person giving above consents

Relationship to Participant

Parent/Legal Guardian Self - if 18 years of age or older

Electronic Signature of initials w/ Date of Birth, Last 4-Digits of Social Security Number or other unique ID

Program Expenses & Donations

“Our goal is to form Strong Catholic Families. We aim to provide quality faith formation and family opportunities. Families are requested to cover a portion of the formation program expenses: $95 per child/teen (pre-K through 12th grade), with a maximum of $285 per family. However, we will always provide full and partial scholarships, as well as payment plans, to families with financial hardships. (These costs are prorated when more than three child participants register from the same family household).”

Payment

OPTIONAL: I would like to make an ADDITIONAL donation to assist YM programs or provide scholarships for youth with a financial need.

Questions or Comments for YM Staff

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Middle School 25-26 Registration

Description

Please Fix the Following