Parent Consent Registration

Parent Consent Form

Who is your student?

Date of Birth

Student Email

Student Cell #

Parent Information

Parent #1 Cell

Parent #2 First & Last Name

Parent #2 Cell

PRIMARY Email: Program updates will be sent here.

Student lives with:

Street Address Where Student Resides

New Field:

State

New Field:

Emergency Contact Primary Phone #

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 and social media platforms.

OVER THE COUNTER MEDICATION:

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.

ANNUAL ELECTRONIC COMMUNICATION CONSENT: A priority of our mission within the High School Youth Group 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. To increase our ministry outreach during this academic year, we ask for 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. If a student should reach out one-to-one (1:1) to an adult core member through electronic means, that core member will communicate back: “I have received your message but am unable to reply as you have not copied an additional core member and/or parent on this message. Please resend to me with at least one of these options so I can reply to you. If this is an emergency and you need to communicate with me immediately, reply and include that in your message. Thank you!” “I have received your message but am unable to reply individually as you have not copied an additional core member and/or parent on this message. I have included {Core Member’s Name} with this reply. {reply}” The following is a list of some electronic formats we may use during this school year: Flocknote Parish/organization website stvincentelkhart.org Emailing from a St. Vincent governed email: @svcelkhart.org Texting (between Core Members and Student) Online video streaming (Zoom, Google Classroom, etc) Phone Calls Group Chat (Text) / GroupMe Educationally appropriate websites or applications as chosen by the Director of Youth Ministries (Bishop Barron’s Word on Fire ENGAGE, Fr. Mike Schmitz YouTube/Spotify blog, etc.) 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 Highschool Youth 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.

Photo & Media Consent Release

I agree that , and/or the Diocese of Fort Wayne-South Bend may use photographs, video or other media of my child for any lawful purpose, including but not limited to such purposes as publicity, illustration, advertising, and Web content.

No, I do not grant , the right to take photographs, video or other media of my child.

Parent / Guardian Signature

Contact Info

1108 S Main St, Elkhart, 46516, Elkhart, IN, United States

(574) 293-8231

Admin