Harvest Sunday Youth Registration

Reach out to Amanda Fierce with questions. Thank you! 815-933-8285 x335

2024 Youth Registration for Harvest Sunday

: Registration and Authorization for MBVM Youth Ministry Harvest Sunday event
Which Harvest Sunday route # did you sign up for?
: This form must be completed by a parent or guardian.
Child #1 First and Last Name
Birthdate mm/dd/yy
Child #2 First and Last Name
Birthdate mm/dd/yy
Child #3 First and Last Name
Birthdate mm/dd/yy
Child #4 First and Last Name
Birthdate mm/dd/yy
Home Address
City
State
Zip Code
Parish (or church name if member of a church)


Parents Name
I am able to drive my child(ren): YesNo
Parents Cellphone number
Parents email address
Emergency name and number if parent can't be reached

: Insurance Information in case of emergency
Policy in the name of:
Insurance Company
Name of Physician
Physician phone number
Specific medical allergies, dietary restrictions, chronic illness, or conditions: (type none if none apply)
List of any medications currently using (type none if none are taken)
Authorization: By checking this box I give permission for my child(ren) participate in the Harvest Sunday event with the Maternity BVM Youth Ministry. I hereby release and indemnify, the Diocese of Joliet and Maternity BVM Catholic Church in Bourbonnais, it's staff and volunteers from any and all liability arising from claims of any kind of nature whatsoever from my child's participation in this trip. I understand that my child(ren) is responsible for following certain rules and regulations that are designed for their safety while taking part in this trip.
Hold Harmless: I am a volunteer at Maternity BVM Parish (the “Parish”). I choose to continue to volunteer with the Parish during the COVID-19 global pandemic. I fully understand the risks associated with the COVID-19 virus. I have read and I fully understand the prescribed CDC guidelines and the Diocese of Joliet’s guidelines related to COVID-19 and agree to follow the same. I agree to protect, defend, hold harmless and fully indemnify the Parish and the Diocese of Joliet for any claim or cause of action whatsoever arising out of my volunteer work during this period of time, including any claim related to COVID-19, whether such claim is brought by me or my family members, and whether such claim arises from the alleged negligence of the Parish, its employees, agents or volunteers.
Medical Authorization: By checking this box I grant permission for the administration of First Aid to my child by the people in charge of this trip and those transporting my child to and from as their judgement deems advisable, and to make the necessary referrals to qualified physicians for treatment of illness or accidents of a more serious nature. I understand that I will be promptly notified in the event of any serious illness or accident and prior to any major surgery, except when delay in such communication would endanger life. In case of medical emergency, I understand that every effort will be made to contact the parent/guardian of the participant. In the event that I cannot be reached, I hereby give permission to the physicians selected by the adult staff/volunteer to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery, if deemed necessary for the child.
Code of Conduct: By checking this box I understand that the following Code of Conduct must be followed: Arrive on time. Demonstrate common courtesy and respect at all times. Inappropriate language/behavior will not be tolerated. Socialize in public areas. Dress modestly. Writing on clothing should reflect Christian values. The possession or consumption of any alcoholic beverage and/or possession/use of any illegal drug is not permitted. Smoking or vaping is not allowed. Weapons and/or drug paraphernalia are not allowed. If under the age of 18, prescription drugs need to be given to an adult from our parish for storage and distribution. Infraction of any of these rules can mean immediate dismissal with no refund. Participants will be responsible to local authorities as well. I understand and agree to this Code of Behavior. I also understand and agree that at the time of infraction requiring my child's dismissal, I am responsible for my child's removal from the premises and any costs involved.
Use of Photographs/Videos for Marketing Purposes Permissions: I grant permission for my child to be photographed or videotaped or the purpose of promotional efforts on the church's social media, website and/or newsletter and bulletin.

Harvest Sunday Youth Registration

Registration and Authorization for MBVM Youth Ministry Harvest Sunday event

Insurance Information in case of emergency

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