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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, bulletins and social media platforms.
  
  PHOTO PERMISSION: Agree Disagree
  
  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 Youth 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.
  
  We truly believe that the number one way for our high schoolers to live a Catholic lifestyle now, and into the rest of their lives is by having examples of the faith who they know are walking with them. A key element to this discipleship is communicating with students throughout the week to check in on prayer and overall well being of the teens.
  
  To increase our ministry outreach during the 2024-2025 school year, we ask 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.
  
  The following is a list of some electronic formats we may use during this school year:
  Flocknote
  Email
  Texting (between Core Members and Student)
  Phone Calls
  Group Chat / Groupme
  
  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
  
  PRAYER PERMISSION
  Part of the ministry we do here at The Well is the opportunity to receive prayer. Throughout the year, there will be unique opportunities for receiving personal prayer and to offer prayer for others. Prayer teams will be available for impartations for greater anointing, Baptism of the Holy Spirit, physical healing and more.
  
  I hereby allow my child to participate in prayer ministry. I understand that the prayer teams have been trained and I grant permission for my child to receive prayer. Please select this field.
  
  PARENT/GUARDIAN SIGNATURE
  By typing my name and submitting this form, I agree that this can be used as a legal signature:
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Submit
  
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