Youth Registration Form

Youth

Tell us about your child

First Name*

Middle Name

Last Name*

Preferred Name

Date of Birth

Gender

Grade

Shirt Size

School

Parish

Home Address

Street Address

City

State

ZIP

Parent / Guardian

Required — this is our main contact

Name*

Relationship

Phone

Email

Second Parent / Guardian

Optional

Name

Relationship

Phone

Email

Emergency Contact

If different from above

Name

Relationship

Phone

Medical Information

Helps us keep your child safe

Allergies, conditions, medications & dietary needs

List anything we should know: allergies, medical conditions, medications your child takes, and any dietary restrictions. Write “None” if nothing applies.

Permission Slip

Please read each section and sign at the bottom. This is required to complete registration.

1. Activity & Medical Release*

I grant permission for my child(ren) to take part in Saint Thomas Parish Youth Ministry (Youth Group) activities during the 2026–2027 program year. As parent/legal guardian, I remain legally responsible for my child(ren)'s actions. On behalf of myself, my child(ren), and our heirs and assigns, I agree to hold harmless and defend Saint Thomas Parish and the Diocese of Covington — and their officers, employees, agents, chaperones, and representatives — from any claim arising from my child(ren)'s participation, including any illness, injury, death, or medical cost, and to cover reasonable attorney's fees they incur in any resulting action, except for claims arising from the negligence of Saint Thomas Parish or the Diocese of Covington. In the event of an accident or sudden illness, I understand reasonable effort will be made to reach me or my emergency contact, and I authorize the leaders to secure emergency medical care if needed. Except for any allergies or restrictions I have listed in my registration, I warrant that to the best of my knowledge my child is in good health, and I assume responsibility for my child's health.

I have read and agree.*

2. Photo & Media Release (optional)

I grant Saint Thomas Parish permission to use my child(ren)'s photograph, image, likeness, voice, and video/audio recordings for promotional purposes involving Saint Thomas Parish and its Youth Ministry, with or without my child(ren)'s name. These may appear in the parish bulletin, website, social media, and diocesan publications. This consent is optional and does not affect my child(ren)'s participation in Youth Ministry.

I GRANT permission.I do NOT grant permission.

3. Sensitive Topics Acknowledgment*

Saint Thomas Youth Ministry may address sensitive topics — such as mental health, suicide, self-harm, sexuality, pornography, substance abuse, and abortion — whether as a planned activity or raised spontaneously by youth, and including topics not listed here. These conversations are handled at age-appropriate levels, grounded in the teaching of the Catholic Church, and always directed to the good of the human person. Parents remain the primary educators of their children; this ministry supports, and does not replace, that role, and parents are welcome to speak with leaders at any time. When a sensitive session is planned in advance, we will make reasonable effort to notify parents beforehand, and a parent may ask that their child be excused from that session. Please note: leaders are not counselors, therapists, or medical professionals. What a young person shares is not held in strict confidence when safety is involved; under Kentucky law, every adult is a mandatory reporter of suspected child abuse or neglect. These are pastoral and educational conversations — not the Sacrament of Reconciliation — and do not carry the seal of confession. When safety is a concern, leaders will follow the Diocese of Covington Safe Environment policies and involve parents, clergy, and qualified professionals as needed.

I have read and understand.*

4. At the end of Youth Group activities, how will your child leave?*

Select as many as apply.

Picked up by parent/legal guardianPicked up by another approved adult (name below)Drives themselves / provides own transportationWalks or bikes homeRides with another family / carpool (name below)Other (please describe)

I confirm the departure plan above and give permission for my child to leave by that method. I understand it is my responsibility to notify a Youth Ministry leader in advance if the plan changes for a given event, and that Saint Thomas Parish supervises students only for a 15-minute grace period after an event’s scheduled end time.

I agree.*

Signature

Type your full name to sign*

Relationship

Date: September 5, 2026

By typing my name I electronically sign this permission slip, affirm the statements above, and confirm the information in this registration is accurate to the best of my knowledge.