St Andrew the Apostle Catholic Church and School |

Please complete a separate form for every student, including all required details in the form. For Saltire membership details and costs, click here.

1. EVENT INFORMATION

Registering for (Select ALL that apply for this student): Grades 6-8 Grades 9-12 without Confirmation Grades 9-12 plus Confirmation Sanctimonia Only - $60 or free with Saltire membership Benedictine Brothers Only - $60 or free with Saltire membership

2. PARTICIPANT INFORMATION

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

Last Name REQUIRED Please fill out this field. Please enter valid data.
Gender REQUIRED Male Female Please fill out this field.
Birthdate--MM/DD/YYYY format REQUIRED Please fill out this field. Please enter valid data.
Life-Threatening Health Concerns or Food Allergy? Self-manageable? REQUIRED
Any health concern the teacher should know about? Please elaborate on whether this condition is self-manageable and what precautionary measures need to be taken.
Please fill out this field. Please enter valid data.
Grade (2018-2019) REQUIRED Sixth Grade Seventh Grade Eighth Grade Ninth Grade Tenth Grade Eleventh Grade Twelfth Grade Please fill out this field.
What school does student attend? REQUIRED Please fill out this field. Please enter valid data.
Baptized as a Catholic REQUIRED Yes, Baptized as a Catholic No, please give me info on receiving Baptism No, not Baptized as a Catholic Please fill out this field.
Baptized? List church name, city, state and year or put N/A if Sacrament not received REQUIRED Please fill out this field. Please enter valid data.
Received First Holy Communion? List church name, city, state and year or put N/A if Sacrament not received REQUIRED Please fill out this field. Please enter valid data.
Confirmed? List church name, city, state and year or put N/A if Sacrament not received REQUIRED Please fill out this field. Please enter valid data.
Playing Sports in the Parochial League Yes, I understand my student must attend 75% of classes to maintain league eligibility. No, BUT my student is interested in playing in the parochial league. No, my student is not playing in the parochial league.

3. PARTICIPANT PERMISSION OF GUARDIAN

Student Name REQUIRED Please fill out this field. Please enter valid data.
I/We, the parent(s)/guardian(s) of the student listed above, request that he/she be allowed to participate in the Event described above, and hereby give my/our permission for such participation.
For the above statement: I agree. I do NOT agree.
I/We give my/our permission to the sponsoring Diocese/Parish/School/Organization to take photographs, video or digital images of Participant during any events for future promotional purposes.
For the above statement: I agree. I do NOT agree.

4. CONSENT FOR DISCLOSURE TO INDIVIDUAL INVOLVED IN THE CARE AND TREATEMENT OF PARTICIPANT

For the duration of the Event, I/We grant to the Diocese/Parish/School/Organization and its agents the following powers, to be used for the benefit of and on behalf of Participant:

A. to receive any and all individually identifiable health information about the past, present and future medical condition of Participant, including, but not limited to, information necessary to the care and treatment of Participant and any illness or injury Participant may have sustained;
Pertaining to Statement A: REQUIRED I agree I do NOT agree Please fill out this field.
B. to authorize medical care for Participant, including, but not limited to, any and all treatment, examination, diagnosis or outpatient medical care rendered under the general or special supervision of and on the advice of any physician or surgeon licensed to practice medicine by the applicable licensing body in the state in which physician or surgeon practices.
Pertaining to Statement B: REQUIRED I agree I do NOT agree Please fill out this field.
C. I/We understand that the Diocese / Parish / School / Organization will not be liable to me/us or any or my/our successors in interest for any action taken or not taken in good faith.

I/We understand that as parent(s) or legal guardian(s), I/we may be responsible for any liability which may result from the conduct of Participant at or during the weekly sessions or events. I/We understand that there is a risk of injury involved in any Youth Ministry activity.

I/We hereby release the Diocese of Kansas City-St. Joseph, and its officers, agents, employees and volunteers, from any liability arising from claims of any kind or nature whatsoever in connection with Participant's participation in the weekly sessions and events.
Pertaining to Statement C: REQUIRED I agree I do NOT agree Please fill out this field.
If you do not agree with any of the above statements, please explain here. Please enter valid data.

5. TEXTING NOTIFICATIONS

The staff of St. Andrew's Saltire primarily communicates upcoming events and reminders through e-mails to parents (information can also be found in St. Andrew's weekly bulletin). Text notifications may also be sent to students and are in the form of a group text. In order to text your teen, your permission must be given to the Saltire staff (Youth Director, Assistant Youth, and/or small group leaders.)

Please complete this section to grant or deny us permission to text your child. For parents wanting to be included in text notifications, please email Carolyn at saltire@sataps.com. Please include the following information: "I would like to be included with group texts that are sent to my teen" or "I would like to receive all text communication to my teen, including quick replies to your teen's question." Please note that it is your responsibility to email Carolyn and indicate your exact preferences for texting notifications. If no preferences are indicated, you will only receive group text notifications.
Select One: REQUIRED Yes, you MAY directly text my teen. No, you MAY NOT directly text my teen. N/A, my teen does not have a phone. Please fill out this field.
Teen Cell Number (xxx) xxx-xxxx Please enter valid data.

FAMILY INFORMATION

FAMILY LAST NAME REQUIRED Please fill out this field. Please enter valid data.
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.
Home Phone REQUIRED Please fill out this field. Please enter a phone number.
Registered Parishioners of St. Andrew REQUIRED Yes, we have a recordable tithe at St. Andrew the Apostle. Yes, we are registered but we do NOT have a recordable tithe. We understand we will need to pay the non-parishioner fee. No Please fill out this field.
Are Both Parents Catholic REQUIRED Yes, both parents are Catholic No, neither parent is Catholic No, only the mother is Catholic No, only the father is Catholic Please fill out this field.

FATHER INFORMATION

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

Last Name REQUIRED Please fill out this field. Please enter valid data.
Work Phone REQUIRED Please fill out this field. Please enter a phone number.
Cell Phone REQUIRED Please fill out this field. Please enter a phone number.
Email REQUIRED Please fill out this field. Please enter an email address.

MOTHER INFORMATION

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

Last Name REQUIRED Please fill out this field. Please enter valid data.
If student is being confirmed, please list mother's maiden name: Please enter valid data.
Work Phone REQUIRED Please fill out this field. Please enter valid data.
Cell Phone REQUIRED Please fill out this field. Please enter valid data.
Email REQUIRED Please fill out this field. Please enter an email address.

How are you paying for Youth Ministry REQUIRED Payment Plan - Set up with Business Office Paying in Full - Submitting Online Paying in Full - Delivering Payment to Office Please fill out this field.

Comments

ELECTRONIC SIGNATURE

The above student has permission to attend this event. By typing my signature below, I attest that I am the legal parent /guardian of the student. Type Signature Below REQUIRED Please fill out this field. Please enter valid data.