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HSM Parent Registration Form

Step #2: Parent Consent Information
- The maximum number of form submissions has been reached. This form is currently not available.
  
  WHO IS YOUR STUDENT?
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Student Email REQUIRED Please fill out this field. Please enter an email address.
  
  Student Cell# REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  PARENT INFORMATION
  
  Parent #1 First/Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent #1 Cell REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Parent #2 First/Last Name Please enter valid data.
  
  Parent #2 Cell Maximum 20 characters Please enter a phone number.
  
  PRIMARY Email: Program updates will be sent here. REQUIRED Please fill out this field. Please enter an email address.
  
  Student Lives With: REQUIRED Please fill out this field.
  
  Street Address Where Student Resides 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.
  
  EMERGENCY INFORMATION
  
  Emergency Contact First/Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact Primary Phone# REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  FAMILY CONCENT FORMS
  
  PHOTO PERMISSION:
  I give permission for photos, videos and/or other medica of my child for any lawful purpose, including but not limited to such purposes as publicity, illustration, advertising, Web content and social media platforms.
  
  PHOTO PERMISSION: Agree Disagree
  
  CARPOOL LIST:
  I give permission to share my name, phone number, email address and neighborhood name on a public document, within High School Ministry Families. I understand this information will be used for other families to contact me regarding setting up carpool options as needed. I do not hold the Diocese of Fort Way-South Bend, St. Vincent de Paul Church Staff, and/or St. Vincent de Paul High School Youth Ministry Director/Core Members responsible for coordination of rides for family carpool opportunities.
  
  CARPOOL LIST: Agree Disagree
  
  If AGREE with Carpooling: Neighborhood OR Nearest Landmark near your home. Please enter valid data.
  
  OVER THE COUNTER MEDICATION REQUIRED No medication, of any type, whether prescription or non-prescription, may be administered to my child unless the situation is life threatening and emergency treatment is required I hereby grant permission for non-prescription medication (i.e. non-aspirin products such as acetaminophen or ibuprofen, throat lozenges, cough syrup) to be given to my child, if deemed appropriate. Please fill out this field.
  
  ANNUAL ELECTRONIC COMMUNICATION CONSENT:
  A priority of our mission within the High School Life Teen Ministry is to help lead young people into a relationship with God, and to create a community of friends and believers among each other. Since so much of our teens’ communication happens through technology, we have found it helpful in our ministry to be able to reach out to teens in different ways.
  
  To increase our ministry outreach during this academic year, we ask for your permission to allow our adult core members to reach out to your student(s) through a variety of technology platforms which are listed below. Our ministry may use these and other means of communication throughout your child's participation in our program.
  
  This consent form is asking parent/guardian permission for adult core members to communicate electronically to your student. Our policy is to have two or more core members included in any group or individual communication with students. All communication by our core members will abide by Diocesan policies with behavior between adults and minors (Safe Environment Policy). This is to protect both our students and our core members.
  
  If a student should reach out one-to-one (1:1) to an adult core member through electronic means, that core member will communicate back:
  
  “I have received your message but am unable to reply as you have not copied an additional core member and/or parent on this message. Please resend to me with at least one of these options so I can reply to you. If this is an emergency and you need to communicate with me immediately, reply and include that in your message. Thank you!”
  
  “I have received your message but am unable to reply individually as you have not copied an additional core member and/or parent on this message. I have included {Core Member’s Name} with this reply. {reply}”
  
  The following is a list of some electronic formats we may use during this school year:
  
  Flocknote
  
  St. Vincent governed Google number
  
  Parish/organization website saintv.org
  
  Email within Learning Management Software (Canvas, etc)
  
  Emailing from a St. Vincent governed email: @saintv.org
  
  Texting (between Core Members and Student)
  
  Online video streaming (Zoom, Google Classroom, etc)
  
  Phone Calls
  
  Group Chat (Text) / GroupMe
  
  Educationally appropriate websites or applications as chosen by the Director of Youth Ministries (Bishop Barron’s Word on Fire ENGAGE, Fr. Mike Schmitz YouTube/Spotify blog, etc.)
  
  I grant my child permission to participate in the forms of electronic communication listed above in relation to the various programming events of St. Vincent de Paul High School Ministry. As the parent/guardian, I choose the following form of communications with my minor child:
  
  DEFINITIONS OF COMMUNICATION:
  
  PARENT ONLY: I do not give permission for my child to receive any electronic communication from Core members; however, Core members may contact me (as the parent) directly.
  
  PARENT AND STUDENT: I give permission for my child to be included in individual and group communications with two Core members, and I would like to be copied in all those exchanges.
  
  TWO ADULT CORE MEMBERS: I give permission for my child to be included in individual and group communications with two Core members.
  
  Annual Electronic Communication Parent Consent REQUIRED Parent Only Parent AND Student TWO Adult Core Members Please fill out this field.
  
  Each parent/guardian is responsible in reviewing this communication information with their child each year. As the parent, we request that you communicate directly to our Youth Ministry Office if you have additional questions regarding the electronic communication consent. We also ask that you contact our Youth Ministry Chaplain if you know of any 1:1 communication being used for ministry purposes within our ministry. We will be more than happy to assist you to the best of our ability
  
  PARENT/GUARDIAN SIGNATURE
  
  To complete your registration, please visit this PandaDoc link to sign your official signature. Please make sure both this form and the PandaDoc form are submitted.
  
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