2014 2015

Registration Form
Student Name:
Parent/Guardian Names:
Street Address:
Town, State Zip Code
Home Phone: Cell:
Church:
Gender: Male Female
Date of Birth:
Grade:
School:

New Member? Yes No

Parent E-mail Address:

**Member E-mail Address**:
I understand that the purpose of St. Joseph High School Youth Group (HSYG) is to allow me
opportunities for faith, friendship, service and fun in a Catholic setting.

When taking part in any HSYG meeting or event, I promise to be respectful in both my lan-
guage and behavior. I will respect the Advisors, my fellow Youth Group Members, the
buildings and grounds and the property of others. I will also be respectful of myself and of
God who made me.

I realize that participation in the monthly HSYG Meetings is a pre-requisite for participation
in HSYG trips and that at least one day trip and one service activity is required to be eligible
for an overnight trip each semester, I realize that missing any monthly meeting commitment
may result in losing my place on a trip and that trip payments are not refundable.

Member Signature__________________________________________ Date:___________________


FOR THE PARENTS AND GUARDIANS

MEDICAL AND PHOTO RELEASE

The following information must be on file.
Please PRINT clearly.

Student Name:_________________________________________________
Parent/Guardian Names:_________________________________________________
Insurance Co.: ____________________________ Policy #:__________________________
Family Physician: __________________________ Phone #:__________________________
Allergies or Medications: ________________________________________

In signing this form, I hereby certify that I am the parent or legal guardian of the participant. I hereby give my
approval for my child's/ward's participation in HSYG Monthly Meetings or planned events. In the case of
injury, illness, or medical emergency, I give permission to the physician attending to my child/ward for the
release of pertinent medical records as well as permission to secure proper and necessary treatment, in-
cluding hospitalization, on behalf of my child/ward.

I hereby indemnify and hold harmless the Archdiocese of Boston and St. Joseph Parish of Medway,
Massachusetts, as well as any and all of their agents, personnel, employees, and volunteers, from any and all
liability for injury, loss, or other claim that could arise from my child's/ward's participation in HSYG Monthly
Meetings or planned events.

I further agree that if my child violates drug or alcohol prohibitions, or otherwise seriously violates good be-
havior, that I will come and get them immediately, or arrange for their immediate transportation home at my
own expense.

I realize that photographs are taken at HSYG Monthly Meetings and planned events for use in HSYG advertis-
ing and Parish Life, and I hereby grant my permission for this. Students are never identified by name. I am
aware and agree that participation in HSYG Monthly Meetings is a prerequisite for taking part in any HSYG
trips or planned events. Please check the box if you do not have access to email:

Signature of Parent or Guardian: ____________________________________ Date: _________________
St. Joseph Parish
High School Youth Group