Youth Group Registration - St. Patrick Catholic Church

Name of Student *

First

Last

Grade Fall 2020 *

Parent Name: *

First

Last

Parent Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Parent Email *

Parent Phone *

Emergency Contact (in addition to Parent) *

First

Last

Emergency Phone *

Student Email *

Student Phone *

Family is registered members of St. Patrick Gretna. If not, please contact Parish Office at 402.332.4444. *

Comment or Message

Disclosure *

I/we grant permission for my/our child(ren), to participate in all parish events that require transportation to a location away from the parish site. These activities will take place under the guidance and direction of parish employees and/or volunteers from St. Patrick’s Catholic Church of Gretna. As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor (“participant”). I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend St. Patrick’s Catholic Church of Gretna, its officers, directors, employees and agents, and the Archdiocese of Omaha, its employees and agents, chaperons, or representatives associated with the event, from any claim arising from or in connection with my child attending the events or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the parish, its officers, directors and agents, and the Archdiocese of Omaha, its employees and agents and chaperons, or representative associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the parish/diocese.

I will pay my registration fees by: *