N Seattle

Catholic Youth

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Registration

- About NSCY

Register for N Seattle Catholic Youth!

Register for N Seattle Catholic Youth's Ministires for the 2019/2020 school year here! If you have any questions, please contact Mariah Nickerson at mariah@stbens.net or 206-488-5970.
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- Student 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.
- Email Please enter an email address.
- Home 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.
- Birthday: REQUIRED Please fill out this field. Please enter a date.
- Gender: REQUIRED Please fill out this field. Please enter valid data.
- School: REQUIRED Please fill out this field. Please enter valid data.
- Grade (as of Fall 2019):
- Parish: REQUIRED Please fill out this field. Please enter valid data.
- T-Shirt Size: REQUIRED Please fill out this field. Please enter valid data.
- What extracurricular activities/hobbies are you a part of?
- Parent/Guardian Information:
- Name(s) and Relationship to Student: REQUIRED Please fill out this field.
- Parent/Guardian Primary Email: REQUIRED Please fill out this field. Please enter an email address.
- Other Parent/Guardian Email (if applicable): Please enter an email address.
- Parent/Guardian Phone Number(s): REQUIRED Please fill out this field.
- Consent and Liability Wavier:
  
  I grant permission for my child to participate in N Seattle Catholic Youth sponsored events that are scheduled to take place from September 2019 to September 2020. These activities and events include Sunday Gatherings, Discipleship Groups, Confirmation, social events such as Turkey Bowl Game, Christmas Party, Super Bowl Party and more. These activities will take place under the guidance and direction of organization employees and/or volunteers from N Seattle Catholic Youth and its partnering parishes.
  
  As the parent and/or legal guardian, I remain legally responsible for any personal actions take by the minor named on this form.
  
  I agree on behalf of myself, my child named herein, or our heirs, successors and assignments, to hold harmless and defend N Seattle Catholic Youth, it's partnering parishes, its officers, directors, and agents, and the Corporation of the Catholic Archbishop of Seattle, chaperones, or representative associated with the event, from any and all actions, claims, demands, damages, costs, expenses, and all consequential damage arising from or in connection with my child attending the events or in connection with any illness or injury or cost of medical treatment in connection therewith, and I agree to compensate the organization, its officers, directors and agents, and the Corporation of the Catholic Archbishop of Seattle, chaperones, or representatives associated with the event for reasonable attorney's fees and expenses arising therewith.
- I Agree Please select this field.
- E-Signature: REQUIRED
  Please sign this wavier by clicking "I Agree" and typing your name below:
  Please fill out this field. Please enter valid data.
- Medical Matters:
- In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment.
  
  If I cannot be reached, I request the Program Coordinator act in the best medical interest of my child. I agree to assume all expenses for medical transportation and/or treatment. I also hereby consent to any treatment, surgery, diagnostic procedure or the administration of anesthesia which may be carried out based on the medical judgment of the attending physician.
- I Agree Please select this field.
- E-Signature: REQUIRED
  Please sign this wavier by clicking "I Agree" and typing your name below:
  Please fill out this field. Please enter valid data.
- Emergency Contact Name and Phone Number: REQUIRED
  In the event of an emergency, the parent/guardian will be contacted as soon as it is safe and reasonable. In the event that the parent/guardian cannot be reached, the emergency contact listed below will be contacted:
  Please fill out this field.
- Family Physician and Phone Number: REQUIRED Please fill out this field.
- Medical Insurance Company: REQUIRED Please fill out this field.
- You should be aware of the following medical conditions of my child (please include any allergies, dietary needs, physical limitations, or medical conditions): REQUIRED Please fill out this field.
- Photograph and Video Consent:
  From time to time, pictures and video may be taken of youth ministry/parish/school events and gatherings. We would like to able to use these photographs and videos for flyers, parish and diocesan publications, and the ministry website. Written consent of both the student and the parent/guardian is required. Names will not be posted unless written authorization is given by the student and parent/guardian, and then only first names will be used. If there are concerns about pictures or videos posted on the website, please contact the organization or webmaster, and they will promptly be removed.
  
  I authorize and give full consent, without limitation or reservation, to N Seattle Catholic Youth and partnering parishes to publish any photograph or video in which the named student appears while participating in any program associated with N Seattle Catholic Youth. There will be no compensation for use of any photograph or video at the time of publication or in the future.
- I Agree Please select this field.
- E-Signature: REQUIRED
  Please sign this wavier by clicking "I Agree" and typing your name below:
  Please fill out this field. Please enter valid data.
- Thank you for registering for N Seattle Catholic Youth.
  
  Your registration will be complete once you have clicked the Submit button and received a confirmation email.
  
  If you have any questions, please feel free to contact Mariah Nickerson at mariah@stbens.net or 206-488-5970.
Submit