Youth Faith Formation Registration 2022-23

Step 1: Complete ONE Registration Form Per Student
Step 2: Pay on-line HERE or bring/mail in cash/check

Student Last Name REQUIRED Please fill out this field. Please enter valid data.

Student First Name REQUIRED Please fill out this field. Please enter valid data.

Street 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.

Is Family Currently Registered with Our Parish? REQUIRED Yes No, Please Register Us Please fill out this field.

Is this a NEW address? (Different from Parish Registry) REQUIRED Yes No Please fill out this field.

Current Grade in School REQUIRED Please fill out this field.

Current School Attending REQUIRED Please fill out this field. Please enter valid data.

Date of Birth REQUIRED Please fill out this field. Please enter a date.

Has Child/Teen Been Baptized REQUIRED Yes No Please fill out this field.

Has Child/Teen Received Sacrament of Reconciliation (Penance)? REQUIRED Yes No Please fill out this field.

Has Child/Teen Received Sacrament of Eucharist (Holy Communion)? REQUIRED Yes No Please fill out this field.

Program Enrollment REQUIRED 2nd Grade Sac Prep 1 - Faith Formation/Reconciliation 3rd Grade Sac Prep 2 - Faith Formation/Eucharist 4th/5th Grade Faith Formation (Peacemakers) 6th-8th Grade Middle School (The EDGE) High School Confirmation (1st Year Preparation) High School Confirmation (2nd Year Preparation) Please fill out this field.

High School Student Cell # Please enter a phone number.

High School Student Email Address Please enter an email address.

Medical Info/Special Needs of Student (ie. medications, allergies, conditions we should be aware of)

Insurance Carrier Name/Name of Policy Holder/Policy Number REQUIRED Please fill out this field.

Emergency Contacts Name/Phone - Anyone other than parents authorized to pick-up/give rides (please list at least one) REQUIRED Please fill out this field.

Parent/Guardian #1 Name REQUIRED Please fill out this field. Please enter valid data.

Relationship to Student REQUIRED Please fill out this field. Please enter valid data.

Religion Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Parent/Guardian #2 Name Please enter valid data.

Relationship to Student Please enter valid data.

Religion Please enter valid data.

Phone Number Please enter a phone number.

Email Please enter an email address.

PHOTO RELEASE

There are occasions when our parish of San Agustin or the Diocese of Monterey would like to use pictures or video taken for print photos, videos, websites, brochures, directories, or other publications (we do not use name identification in photos or video). I authorize and give permission to San Agustin Church and the Diocese of Monterey to use photos or video taken of me or my child/teen for parish or diocesan use as stated. I acknowledge that I hereby release and forever discharge the Diocese of Monterey and its officers, agents, and employees from and against any and all claims, damages or suits which may arise from the use of the Diocese of Monterey and/or parish publications, press/media releases or website.

PHOTO RELEASE/PERMISSION REQUIRED I DO give permission for photos/video to be taken of my child I DO not give permission for photos/videos to be taken of my child, but understand they may appear in unidentified group photos Please fill out this field.

PHOTO RELEASE/ACKNOWLEDGEMENT Electronic Signature: Parent/Guardian (Name/Date) REQUIRED Please fill out this field. Please enter valid data.

ANNUAL STUDENT SAFE ENVIRONMENT TRAINING

All students will be provided the opportunity to participate in our diocesan sponsored Safe Environment Sexual Abuse Prevention Training, Protecting God's Children™ program. The age-appropriate lessons will be offered during at least one regular class time as an ongoing effort to create and maintain a safe environment for children and protect all children from sexual abuse. The exact date will be listed on class schedules and also communicated via email at least one week before. See the parent handout with program overview located on this registration web page. Additional program materials are available in the parish office for your review or you may visit the VIRTUS Online™ website at www.virtus.org for more information.

PERMISSION to Participate in Student Safe Environment Training REQUIRED I DO give permission for my child to participate in Protecting God's Children Safe Environment Training I DO NOT give permission for my child to participate in Protecting God's Children Safe Environment Training Please fill out this field.

DIOCESE OF MONTEREY PERMISSION WAIVER, RELEASE AND CONSENT FOR TREATMENT FORM FOR PARISH/SCHOOL ACTIVITY/EVENT
To the Parent/Legal guardian: This is an agreement releasing the sponsoring parish/school before, during and after the activity/event. This form is also authorization for the adult supervisor to consent to any medical care needed by the minor if the situation should arise. This agreement releases the ROMAN CATHOLIC BISHOP OF MONTEREY, CALIFORNIA, A CORPORATION SOLE, also known as the DIOCESE OF MONTEREY which will be referred to as the DIOCESE OF MONTEREY throughout this document, from any claims that the parent/guardian may have against the DIOCESE OF MONTEREY.

Activity/Event: San Agustin Parish – Faith Formation Classes/Activities from September 2022 - September 2023

Mode of Transportation: Parents are responsible for transportation to and from events unless student is a licensed driver.

As the parent or legal guardian of the above named student, I hereby give my permission for my child/teen to participate in the youth activity named above. I agree to direct my children to cooperate and conform with directions, instructions and rules established by the chaperone, parish or diocesan personnel responsible for the above mentioned youth activity.

In exchange for permitting my children to participate in the above named activity, to the extent permitted by law, I waive all claims for damages which I may have or which may hereafter accrue to me or my child/teen against the DIOCESE OF MONTEREY, for death, personal injuries, and losses or injuries to property, real or personal, caused by or arising out of the above named activity/event. It is further understood and agreed that this agreement, waiver and release is to be binding on my successors, heirs and assigns.

In addition, to the extent permitted by law, I release and discharge in advance the DIOCESE OF MONTEREY and its officers, agents, employees, from any and all liability relating to the above named activity.

I agree and understand that transportation may be provided in such form and at the discretion of the DIOCESE OF MONTEREY.

My child/teen is physically fit and capable of participation in this event.

I authorize a representative of the DIOCESE OF MONTEREY into whose care the above named minors has been entrusted, to consent to and permit any and all necessary medical services for my child/teen to be rendered to him/her under the general or special supervision and upon the advice of a physician and surgeon licensed under the surgical diagnosis or treatment and hospital care rendered to my child/teen by a dentist licensed under the provisions of the Dental Practice Act. I hereby give the representative of the DIOCESE OF MONTEREY permission to use his/her judgment obtaining medical services. I agree if medical services are required for my child/teen, the DIOCESE OF MONTEREY will not be responsible for any medical expenses.

It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and power on the part of the above mentioned diocesan representative to give specific consent to any and all such diagnosis, treatment or hospital care that the above mentioned physician in the exercise of his/her best judgment may deem advisable.

I here by authorize any hospital which has provided treatment to the above named minors pursuant to the provisions of Family Code section 6910 to surrender physical custody of such minors to the diocesan representative upon the completion of treatment. This authorization is given pursuant to Health and Safety Code section 1283.

This authorization shall be in effect during all time that my child/teen is under the supervision of the DIOCESE OF MONTEREY for the above mentioned event and shall remain effective until minor returns from the event and is no longer under the supervision of the DIOCESE OF MONTEREY.

This waiver and release form is signed in order to participate in the above named event for my child/teen’s own personal enjoyment and benefit and is done freely with full knowledge of the risk and dangers that are or may be involved. I, the parent/guardian, have read this release and understand all of its terms. I execute this voluntarily and with full knowledge of its significance. I have discussed the above with my child/teen and he/she is aware of and understands the importance of following all rules set out by the supervisor(s).

I Agree to Diocese Permission/Waiver/Release/Consent for Treatment 2022-23 Please select this field.

PERMISSION/WAIVER/RELEASE Electronic Signature & Date: Parent/Guardian (Type Full Name) & DATE REQUIRED Please fill out this field. Please enter valid data.

Catholic Community
of San Agustín

Scotts Valley, CA

Youth Faith Formation Registration 2022-23

Registration