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Date _______ Paid _______ Ck # _______ FA_________
Our Lady of Mt. Mt. Carmel Faith Formation Office 14598 Oakridge Road Carmel, IN 46032 (317) 846-3878
TOTAL REGISTRATION FEE: $60* CHECKS MADE PAYABLE TO ‘OLMC’
6:45— —8:30pm, beginning September 6 Wednesdays, 6:45 pre--EDGE fun, games, and snacks! Doors open at 6pm for pre
For Financial Assistance, please complete a Financial Assistance application to determine assistance available. Applications are available at www.olmc1.org or contact the Faith Formation Office at 846-3878. All completed forms must be sent to Jayne Slaton—Merciful H.E.L.P. Center.
PLEASE FILL OUT BOTH SIDES OF THIS FORM
Please Print
Youth’s Name:_____________________________________________________ male____ female____ LAST FIRST (preferred name) Parent Email: ________________________________________________________________________ Date of Birth: _____/_____/_____
Age: _______
Grade as of August 2017:________ School Attending 2017-2018: ____________________________
Sacraments Received: Baptism______
Reconciliation______ 1st Holy Communion______
Please Print
Parent Name(s): __________________________ _____________________ ___________________ Last Father Mother
Adult Volunteer Opportunities Name of Volunteer: _____________________________________________
□ one time event/office help □ small group facilitator
□ help with events/lock-ins
*Before volunteering, please complete the Protecting Children in the 21st Century protocol session at https://safeandsacred-dol-in.org/.
Our Lady of Mt. Carmel Parish Media Release We believe that both the youth and the parish benefit from positive recognition. There may be occasion for media coverage concerning your youth throughout the year. We ask permission to release this type of communication. This could include: Newspapers, Newsletters, The Observer, Catholic Moment, and OLMC and Diocesan website. ______ Yes. The parish has my permission to release EDGE related communication involving my youth to the media. ______ No. The parish does not have my permission to release EDGE related communication involving my youth to the media. _____________________________________________
________________
Parent Signature
Date
EDGE MEDICAL EMERGENCY WAIVER ______________________________________________________________________________________________________________________________________
STUDENT:
Last Name
First Name (Preferred Name)
______________________________________________________________________________________________________________________________________________________________________________
Address
City
Zip Code
_________________________________________ __________________________________ __________________________________ __________________________________
Father’s (or guardian’s) Name
Cell Phone #
Work Phone #
Home Phone #
_________________________________________ __________________________________ __________________________________ __________________________________
Mother’s Name
Cell Phone #
Who does your child live with?
Work Phone #
Home Phone #
_______________________________
In case of an emergency and parent is not available, please contact: (List 2 friends or relatives) 1._________________________________________________
_________________________________
Full Name
___________________________________
Phone #
2._________________________________________________
Relationship
_________________________________
Full Name
___________________________________
Phone #
Relationship
Please list allergies (food sensitivities, medication, bee stings, etc.): ______________________________________________________ _________________________________________________________________________________________________________________ You should be aware of the special medical conditions of my child: _______________________________________________________
Child’s Physician: ____________________________________ Office Phone: ____________________ After Hours: _____________________ Hospital Preference:__________________________________________________________ Medical Insurance Provider: ______________________________ Policy #:____________________________________________
I give my permission for Church personnel to obtain needed medical services and to transport to a local hospital the above named student should he or she suffer illness or accident during an EDGE event and the parent(s) cannot be contacted.
_____________________________________________ Parent Signature
______________________ Date