Youth Bible Study

*Submit an individual form for each child.

Student Information

First and Last Name

Student Phone Number

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Grade

Mailing Address

City

State

Zip Code

PARENT/GUARDIAN INFORMATION

Parent Name

First Name

Last Name

Parent's Cell Phone

EMERGENCY CONTACT INFORMATION/ALTERNATIVE RELEASE

Alternate/Emergency Contact Name(Not Parent)

First Name

Last Name

Emergency Contact Cell Phone

PERMISSIONS

Photo/Video Consent and Release

(Parent's/Guardian's initials required below) I hereby authorize St. James Catholic Church to take photographs, recordings, and/or videos (whether electronic, digital, or otherwise) of Participant in connection with the activities, and I hereby consent to the use, reproduction, and publication of such images by St. James Catholic Church in connection with the promotion and publicity of the activities of St. James Catholic Church, including, without limitation, publication of such images on St. James Catholic Church's website, media, etc. I, individually and in my capacity as parent/legal guardian of Participant, hereby waive any right to inspect or approve the actual use by St. James Catholic Church of any such image of Participant. Such images of Participant shall be the sole property of St. James Catholic Church, and I, individually and in my capacity as parent/legal guardian of Participant, acknowledge and agree that neither I nor Participant shall be entitled to any compensation whatsoever should any such images of Participant be used by St. James Catholic Church.

INQUIRIES:

Patricia Gonzalez

 830-672-6291

gonzalesfaithformation@gmail.com