Youth Ministry Participation Form

: Youth Ministry Participation Authorization Form

: STUDENT INFORMATION
Students First & Last Name
Date of Birth
Age
Home address
City, State, & Zip Code
School currently enrolled
School grade
Does student have special needs or allergies: YesNo
If YES, please describe

: PARENTS INFORMATION
Parent(s)/Guardian Name(s)
Home phone #
Parent's cell #
Parent's email address

: PERSON'S AUTHORIZED TO PICK UP CHILD BESIDES PARENTS/GUARDIAN
First & Last Name
Relationship to student

I give permission for my child's image to be used in parish publications/website: YesNo
: By submitting this form, I/We, as the parent(s)/guardian of the above youth, give permission for my child to attend St. Clement Youth Ministry. I fully understand that his/her help will be needed at different parish events and activities. We understand and agree to the rules and discipline actions that will be upheld in Youth Ministry.

St. Clement Catholic Church