Youth Evangelization Registration 2023 - 2024 | Sacred Heart of Jesus - Roman Catholic Church

What parish is your family currently registered? REQUIRED

Please select program registering for

Please fill out this field.

If selected "Other" Please list your parish: Please enter valid data.

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

Mother Last 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.

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

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

Father's First Name REQUIRED Please fill out this field. Please enter valid data.

Father's Last 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.

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

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

How many children are you registering? REQUIRED Please fill out this field.
Child 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Birthday of Child REQUIRED Please fill out this field. Please enter valid data.
- Allergies REQUIRED Please fill out this field. Please enter valid data.
- Where does your child live? REQUIRED Please fill out this field.
- What program are you registering your child for? REQUIRED Please fill out this field.
- Based on the Program you registered for:
  
  CGS - please select what level, day, and time you would prefer
  
  YE - please select the grade you will be entering for school year 2023-2024 and confirm you can attend the offsite opportunities.
- Registering for CGS? What day and time is your 1st preference? REQUIRED Please fill out this field.
- Registering for CGS? What day and time is your 2nd preference? REQUIRED Please fill out this field.
- Registering for YE? What grade will your child be entering for the 2023-2024 School Year? REQUIRED Please fill out this field.
- My child (7th - 12th grade) has my permission to attend the following offsite events for the 23-24 school year. REQUIRED Wed. Aug. 30, 2023 Youth Spirit Event with PJ Anderson at Maria Stein all 9th - 12th graders Wed. Oct. 4th, 2023 - XLT at Minster High School all 7th - 12th graders N/A - not a student in 7th - 12th grades Please fill out this field.
- Does your child have any chronic health issues? If yes please explain. REQUIRED Please fill out this field.
Child 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Birthday of Child REQUIRED Please fill out this field. Please enter valid data.
- Allergies REQUIRED Please fill out this field. Please enter valid data.
- Where does your child live? REQUIRED Please fill out this field.
- What program are you registering your child for? REQUIRED Please fill out this field.
- Based on the Program you registered for:
  
  CGS - please select what level, day, and time you would prefer
  
  YE - please select the grade you will be entering for school year 2023-2024 and confirm you can attend the offsite opportunities.
- Registering for CGS? What day and time is your 1st preference? REQUIRED Please fill out this field.
- Registering for CGS? What day and time is your 2nd preference? REQUIRED Please fill out this field.
- Registering for YE? What grade will your child be entering for the 2023-2024 School Year? REQUIRED Please fill out this field.
- My child (7th - 12th grade) has my permission to attend the following offsite events for the 23-24 school year. REQUIRED Wed. Aug. 30, 2023 Youth Spirit Event with PJ Anderson at Maria Stein all 9th - 12th graders Wed. Oct. 4th, 2023 - XLT at Minster High School all 7th - 12th graders N/A - not a student in 7th - 12th grades Please fill out this field.
- Does your child have any chronic health issues? If yes please explain. REQUIRED Please fill out this field.
Child 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Birthday of Child REQUIRED Please fill out this field. Please enter valid data.
- Allergies REQUIRED Please fill out this field. Please enter valid data.
- Where does your child live? REQUIRED Please fill out this field.
- What program are you registering your child for? REQUIRED Please fill out this field.
- Based on the Program you registered for:
  
  CGS - please select what level, day, and time you would prefer
  
  YE - please select the grade you will be entering for school year 2023-2024 and confirm you can attend the offsite opportunities.
- Registering for CGS? What day and time is your 1st preference? REQUIRED Please fill out this field.
- Registering for CGS? What day and time is your 2nd preference? REQUIRED Please fill out this field.
- Registering for YE? What grade will your child be entering for the 2023-2024 School Year? REQUIRED Please fill out this field.
- My child (7th - 12th grade) has my permission to attend the following offsite events for the 23-24 school year. REQUIRED Wed. Aug. 30, 2023 Youth Spirit Event with PJ Anderson at Maria Stein all 9th - 12th graders Wed. Oct. 4th, 2023 - XLT at Minster High School all 7th - 12th graders N/A - not a student in 7th - 12th grades Please fill out this field.
- Does your child have any chronic health issues? If yes please explain. REQUIRED Please fill out this field.
Child 4
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Birthday of Child REQUIRED Please fill out this field. Please enter valid data.
- Allergies REQUIRED Please fill out this field. Please enter valid data.
- Where does your child live? REQUIRED Please fill out this field.
- What program are you registering your child for? REQUIRED Please fill out this field.
- Based on the Program you registered for:
  
  CGS - please select what level, day, and time you would prefer
  
  YE - please select the grade you will be entering for school year 2023-2024 and confirm you can attend the offsite opportunities.
- Registering for CGS? What day and time is your 1st preference? REQUIRED Please fill out this field.
- Registering for CGS? What day and time is your 2nd preference? REQUIRED Please fill out this field.
- Registering for YE? What grade will your child be entering for the 2023-2024 School Year? REQUIRED Please fill out this field.
- My child (7th - 12th grade) has my permission to attend the following offsite events for the 23-24 school year. REQUIRED Wed. Aug. 30, 2023 Youth Spirit Event with PJ Anderson at Maria Stein all 9th - 12th graders Wed. Oct. 4th, 2023 - XLT at Minster High School all 7th - 12th graders N/A - not a student in 7th - 12th grades Please fill out this field.
- Does your child have any chronic health issues? If yes please explain. REQUIRED Please fill out this field.
Child 5
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Birthday of Child REQUIRED Please fill out this field. Please enter valid data.
- Allergies REQUIRED Please fill out this field. Please enter valid data.
- Where does your child live? REQUIRED Please fill out this field.
- What program are you registering your child for? REQUIRED Please fill out this field.
- Based on the Program you registered for:
  
  CGS - please select what level, day, and time you would prefer
  
  YE - please select the grade you will be entering for school year 2023-2024 and confirm you can attend the offsite opportunities.
- Registering for CGS? What day and time is your 1st preference? REQUIRED Please fill out this field.
- Registering for CGS? What day and time is your 2nd preference? REQUIRED Please fill out this field.
- Registering for YE? What grade will your child be entering for the 2023-2024 School Year? REQUIRED Please fill out this field.
- My child (7th - 12th grade) has my permission to attend the following offsite events for the 23-24 school year. REQUIRED Wed. Aug. 30, 2023 Youth Spirit Event with PJ Anderson at Maria Stein all 9th - 12th graders Wed. Oct. 4th, 2023 - XLT at Minster High School all 7th - 12th graders N/A - not a student in 7th - 12th grades Please fill out this field.
- Does your child have any chronic health issues? If yes please explain. REQUIRED Please fill out this field.
Child 6
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Birthday of Child REQUIRED Please fill out this field. Please enter valid data.
- Allergies REQUIRED Please fill out this field. Please enter valid data.
- Where does your child live? REQUIRED Please fill out this field.
- What program are you registering your child for? REQUIRED Please fill out this field.
- Based on the Program you registered for:
  
  CGS - please select what level, day, and time you would prefer
  
  YE - please select the grade you will be entering for school year 2023-2024 and confirm you can attend the offsite opportunities.
- Registering for CGS? What day and time is your 1st preference? REQUIRED Please fill out this field.
- Registering for CGS? What day and time is your 2nd preference? REQUIRED Please fill out this field.
- Registering for YE? What grade will your child be entering for the 2023-2024 School Year? REQUIRED Please fill out this field.
- My child (7th - 12th grade) has my permission to attend the following offsite events for the 23-24 school year. REQUIRED Wed. Aug. 30, 2023 Youth Spirit Event with PJ Anderson at Maria Stein all 9th - 12th graders Wed. Oct. 4th, 2023 - XLT at Minster High School all 7th - 12th graders N/A - not a student in 7th - 12th grades Please fill out this field.
- Does your child have any chronic health issues? If yes please explain. REQUIRED Please fill out this field.
Child 7
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Birthday of Child REQUIRED Please fill out this field. Please enter valid data.
- Allergies REQUIRED Please fill out this field. Please enter valid data.
- Where does your child live? REQUIRED Please fill out this field.
- What program are you registering your child for? REQUIRED Please fill out this field.
- Based on the Program you registered for:
  
  CGS - please select what level, day, and time you would prefer
  
  YE - please select the grade you will be entering for school year 2023-2024 and confirm you can attend the offsite opportunities.
- Registering for CGS? What day and time is your 1st preference? REQUIRED Please fill out this field.
- Registering for CGS? What day and time is your 2nd preference? REQUIRED Please fill out this field.
- Registering for YE? What grade will your child be entering for the 2023-2024 School Year? REQUIRED Please fill out this field.
- My child (7th - 12th grade) has my permission to attend the following offsite events for the 23-24 school year. REQUIRED Wed. Aug. 30, 2023 Youth Spirit Event with PJ Anderson at Maria Stein all 9th - 12th graders Wed. Oct. 4th, 2023 - XLT at Minster High School all 7th - 12th graders N/A - not a student in 7th - 12th grades Please fill out this field.
- Does your child have any chronic health issues? If yes please explain. REQUIRED Please fill out this field.

Family Doctor Please enter valid data.

Family Doctor's Phone Number Please enter valid data.

Emergency Contact REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Phone Number REQUIRED Please fill out this field. Please enter valid data.

Would you be willing to help teach here at Sacred Heart? REQUIRED Please fill out this field.

Would you be willing to be a small group leader? REQUIRED Please fill out this field.

Would you be willing to be a parking lot monitor? REQUIRED

Please select program registering for

Please fill out this field.

Are there any special instructions/circumstance that we should know about? REQUIRED Please fill out this field. Please enter valid data.

PERMISSION, RELEASE, AND AUTHORIZATION TO SEEK MEDICAL TREATMENT FORM (rev. 7-9-2020)
1. I, the custodial parent/legal guardian of (the “Child”), give permission for my Child to participate in the activity described on the Activity Information Form (the “Activity”) and release from all liability, indemnify, and hold harmless Parish Listed Above, the Archdiocese of Cincinnati (the “Archdiocese”), the Archbishop of Cincinnati (the “Archbishop”), both individually and as trustee for the Archdiocese, all parishes and schools within the Archdiocese, and all of their agents, representatives, volunteers, and employees from any and all liability, claims, judgments, damages, costs and expenses, including attorneys’ fees, arising out of any injury, illness, infectious and/or communicable disease (such as MRSA, influenza, or COVID-19), or death, (including any injury, illness, infectious and/or communicable disease, or death caused by the negligence of Parish and School, the Archbishop, the Archdiocese, any parish or school within the Archdiocese, or any of their agents, representatives, volunteers, or employees) incurred by my Child while participating in the Activity, traveling to or from the Activity, or while using the facilities and equipment of the Parish and School. I further agree not to bring or prosecute or allow to be brought or prosecuted (including, but not limited to, prosecution through subrogation) in my name, or on behalf of my Child, any claims, lawsuits, or actions against Parish and School, the Archbishop, the Archdiocese, all parishes and schools within the Archdiocese, or their agents, representatives, volunteers, and employees.

2. I understand that my Child’s participation in the Activity is purely voluntary and is a privilege and not a right, and that my Child, and I on behalf of my Child, agree to my Child’s participation in the Activity in spite of the risks of injury, illness, infectious and/or communicable disease (such as MRSA, influenza, or COVID-19), and death. I agree that if my Child has underlying health concerns that may place him/her at greater risk of contracting COVID-19 or that would possibly increase the severity of illness if COVID-19 is contracted, then my Child and I will consult with a healthcare professional before participating in the Activity.
3. I agree to instruct my Child to cooperate with the agents of Parish and School and/or the Archdiocese who are in charge of the Activity.
4. I authorize the agents of Parish and School and/or the Archdiocese who are acting as leaders of the Activity to seek medical treatment for my Child in the event of any injury, illness, or medical emergency during the Activity or related travel. I understand that the agents of Parish and School and/or the Archdiocese will make a reasonable attempt to contact me as soon as possible in the event of a medical emergency involving my Child.
5. Please indicate. I __agree __ do not agree that Parish and School and/or the Archdiocese may use my Child’s portrait or photograph for promotional purposes, website, and office functions.
6. Please indicate. I __agree __do not agree that Parish and School and/or the Archdiocese may use social media and technology to communicate with my Child regarding parish/school-related ministry activities.
7. This Permission, Release, and Authorization is intended to be as broad and inclusive as permitted by the law of the State of Ohio, and if any portion hereof is declared invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This Permission, Release, and Authorization shall be construed in accordance with the laws of the State of Ohio, excluding, and irrespective of, any choice of law principles to the contrary. 8. Parish and School, the Archdiocese, the Archbishop and their agents, employees, and volunteers shall have no liability whatsoever in the event the Activity is cancelled due, in whole or in part, to any present or future pandemic, epidemic, widespread disease or illness, public health concern, or circumstances arising therefrom, or from actions taken by any governmental or municipal authority to prevent, avoid, or mitigate the impacts thereof. I have carefully read and understand and accept the terms and conditions stated herein and I acknowledge and agree that this Permission, Release, and Authorization to Seek Medical Treatment

I Agree Please select this field.

I, Parent Agree or do not Agree that Parish and School and/or the Archdiocese may use my Child’s portrait or photograph for promotional purposes, website, and office functions. REQUIRED Please fill out this field.

Please indicate. I  agree  do not agree that Parish and School and/or the Archdiocese may use social media and technology to communicate with my Child regarding parish/school related ministry activities. REQUIRED Please fill out this field.

Payment for All Programs - Each Student registered Regardless of the program is $85 REQUIRED 85.0 – 1 student 170.0 – 2 students 255.0 – 3 students 340.0 – 4 or more students Please fill out this field.

Sacred Heart of Jesus

A Roman Catholic Church (McCartyville)

Youth Evangelization Registration 2023 - 2024

Youth Evangelization & CGS Registration 2023-2024