2017-18 EDGE registration.pub - Our Lady of Mt. Carmel

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Office Use Only

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