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CYM Junior High Registration

- The maximum number of form submissions has been reached. This form is currently not available.
  
  We meet on the 1st and 3rd Friday of most months.
  
  There is a $25.00 fee for the Jr High Youth Group that will cover the cost of t-shirts and help offset the cost of meals.
  
  If your daughter would like to be a part of the Girl's group the kit for that is $50. There is no additional charge for the guy's group.
  
  Payments can be made at the meeting or dropped off at the office.
  
  Family Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Primary Family Cell Number REQUIRED Please fill out this field. Please enter valid data.
  
  Receive Text Message Notifications REQUIRED Yes No Please fill out this field.
  
  Primary Family Email REQUIRED Please fill out this field. Please enter valid data.
  
  Number of Students REQUIRED Please fill out this field.
  
  Student Information 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Student's Email Please enter an email address.
  
  Student's Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Student's School REQUIRED Please fill out this field. Please enter valid data.
  
  Are you registering for the Blaze Girls Group? (The cost is $50 for the girl's kit) REQUIRED Yes No Need more information Please fill out this field.
  
  Student's T-Shirt Size REQUIRED Please fill out this field.
  
  Special Concerns CYM should be aware of:
  
  Medical Problems or Conditions (Allergies, Diabetes, etc.) & Symptoms
  
  RELEASE FORMS
  
  Diocese of St. Augustine | Child Photography Release
  
  Without compensation, I hereby grant permission to the Catholic Diocese of St. Augustine to use and reproduce photographs and/or video taken of my child. These photographs may be used for news and editorial purposes in publications and other electronic reproductions (websites and video, including livestream) and/or brochures.
  
  In addition, I grant my permission to alter the same photos without restriction and to copyright the same. I hereby release the photographer, the journalists and the publications or media outlets they represent, as well as, the parish/church and/or school involved, the Bishop of the Diocese of St. Augustine, a corporation sole, the Catholic Diocese of St. Augustine and all of their employees and agents, from all claims and liability relating to said photographs.
  Updated 8/2020
  
  Media Release REQUIRED I Agree I Disagree Please fill out this field.
  
  Diocese of St. Augustine | Medical Matters
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.
  
  (Of the following statements pertaining to medical matters, sign only in accordance with your wishes.)
  
  Emergency Medical Treatement
  In the event of an emergency, I hereby give permission to Diocese of St. Augustine's employees, volunteers, or representatives to seek medical treatment for my child above named.
  
  In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Diocesan representatives or volunteers to hospitalize, secure proper treatment for, and order injection and/or anesthesia and/or surgery for my child above named.
  
  Medical Matters REQUIRED I Agree I Disagree Please fill out this field.
  
  Student Information 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Student's Email Please enter an email address.
  
  Student's Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Student's School REQUIRED Please fill out this field. Please enter valid data.
  
  Are you registering for the Blaze Girls Group? (The cost is $50 for the girl's kit) REQUIRED Yes No Need more information Please fill out this field.
  
  Student's T-Shirt Size REQUIRED Please fill out this field.
  
  Special Concerns CYM should be aware of:
  
  Medical Problems or Conditions (Allergies, Diabetes, etc.) & Symptoms
  
  RELEASE FORMS
  
  Diocese of St. Augustine | Child Photography Release
  
  Without compensation, I hereby grant permission to the Catholic Diocese of St. Augustine to use and reproduce photographs and/or video taken of my child. These photographs may be used for news and editorial purposes in publications and other electronic reproductions (websites and video, including livestream) and/or brochures.
  
  In addition, I grant my permission to alter the same photos without restriction and to copyright the same. I hereby release the photographer, the journalists and the publications or media outlets they represent, as well as, the parish/church and/or school involved, the Bishop of the Diocese of St. Augustine, a corporation sole, the Catholic Diocese of St. Augustine and all of their employees and agents, from all claims and liability relating to said photographs.
  Updated 8/2020
  
  Media Release REQUIRED I Agree I Disagree Please fill out this field.
  
  Diocese of St. Augustine | Medical Matters
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.
  
  (Of the following statements pertaining to medical matters, sign only in accordance with your wishes.)
  
  Emergency Medical Treatement
  In the event of an emergency, I hereby give permission to Diocese of St. Augustine's employees, volunteers, or representatives to seek medical treatment for my child above named.
  
  In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Diocesan representatives or volunteers to hospitalize, secure proper treatment for, and order injection and/or anesthesia and/or surgery for my child above named.
  
  Medical Matters REQUIRED I Agree I Disagree Please fill out this field.
  
  Student Information 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Student's Email Please enter an email address.
  
  Student's Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Student's School REQUIRED Please fill out this field. Please enter valid data.
  
  Are you registering for the Blaze Girls Group? (The cost is $50 for the girl's kit) REQUIRED Yes No Need more information Please fill out this field.
  
  Student's T-Shirt Size REQUIRED Please fill out this field.
  
  Special Concerns CYM should be aware of:
  
  Medical Problems or Conditions (Allergies, Diabetes, etc.) & Symptoms
  
  RELEASE FORMS
  
  Diocese of St. Augustine | Child Photography Release
  
  Without compensation, I hereby grant permission to the Catholic Diocese of St. Augustine to use and reproduce photographs and/or video taken of my child. These photographs may be used for news and editorial purposes in publications and other electronic reproductions (websites and video, including livestream) and/or brochures.
  
  In addition, I grant my permission to alter the same photos without restriction and to copyright the same. I hereby release the photographer, the journalists and the publications or media outlets they represent, as well as, the parish/church and/or school involved, the Bishop of the Diocese of St. Augustine, a corporation sole, the Catholic Diocese of St. Augustine and all of their employees and agents, from all claims and liability relating to said photographs.
  Updated 8/2020
  
  Media Release REQUIRED I Agree I Disagree Please fill out this field.
  
  Diocese of St. Augustine | Medical Matters
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.
  
  (Of the following statements pertaining to medical matters, sign only in accordance with your wishes.)
  
  Emergency Medical Treatement
  In the event of an emergency, I hereby give permission to Diocese of St. Augustine's employees, volunteers, or representatives to seek medical treatment for my child above named.
  
  In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Diocesan representatives or volunteers to hospitalize, secure proper treatment for, and order injection and/or anesthesia and/or surgery for my child above named.
  
  Medical Matters REQUIRED I Agree I Disagree Please fill out this field.
  
  Student Information 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Student's Email Please enter an email address.
  
  Student's Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Student's School REQUIRED Please fill out this field. Please enter valid data.
  
  Are you registering for the Blaze Girls Group? (The cost is $50 for the girl's kit) REQUIRED Yes No Need more information Please fill out this field.
  
  Student's T-Shirt Size REQUIRED Please fill out this field.
  
  Special Concerns CYM should be aware of:
  
  Medical Problems or Conditions (Allergies, Diabetes, etc.) & Symptoms
  
  RELEASE FORMS
  
  Diocese of St. Augustine | Child Photography Release
  
  Without compensation, I hereby grant permission to the Catholic Diocese of St. Augustine to use and reproduce photographs and/or video taken of my child. These photographs may be used for news and editorial purposes in publications and other electronic reproductions (websites and video, including livestream) and/or brochures.
  
  In addition, I grant my permission to alter the same photos without restriction and to copyright the same. I hereby release the photographer, the journalists and the publications or media outlets they represent, as well as, the parish/church and/or school involved, the Bishop of the Diocese of St. Augustine, a corporation sole, the Catholic Diocese of St. Augustine and all of their employees and agents, from all claims and liability relating to said photographs.
  Updated 8/2020
  
  Media Release REQUIRED I Agree I Disagree Please fill out this field.
  
  Diocese of St. Augustine | Medical Matters
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.
  
  (Of the following statements pertaining to medical matters, sign only in accordance with your wishes.)
  
  Emergency Medical Treatement
  In the event of an emergency, I hereby give permission to Diocese of St. Augustine's employees, volunteers, or representatives to seek medical treatment for my child above named.
  
  In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Diocesan representatives or volunteers to hospitalize, secure proper treatment for, and order injection and/or anesthesia and/or surgery for my child above named.
  
  Medical Matters REQUIRED I Agree I Disagree Please fill out this field.
  
  Student Information 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Student's Email Please enter an email address.
  
  Student's Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Student's School REQUIRED Please fill out this field. Please enter valid data.
  
  Are you registering for the Blaze Girls Group? (The cost is $50 for the girl's kit) REQUIRED Yes No Need more information Please fill out this field.
  
  Student's T-Shirt Size REQUIRED Please fill out this field.
  
  Special Concerns CYM should be aware of:
  
  Medical Problems or Conditions (Allergies, Diabetes, etc.) & Symptoms
  
  RELEASE FORMS
  
  Diocese of St. Augustine | Child Photography Release
  
  Without compensation, I hereby grant permission to the Catholic Diocese of St. Augustine to use and reproduce photographs and/or video taken of my child. These photographs may be used for news and editorial purposes in publications and other electronic reproductions (websites and video, including livestream) and/or brochures.
  
  In addition, I grant my permission to alter the same photos without restriction and to copyright the same. I hereby release the photographer, the journalists and the publications or media outlets they represent, as well as, the parish/church and/or school involved, the Bishop of the Diocese of St. Augustine, a corporation sole, the Catholic Diocese of St. Augustine and all of their employees and agents, from all claims and liability relating to said photographs.
  Updated 8/2020
  
  Media Release REQUIRED I Agree I Disagree Please fill out this field.
  
  Diocese of St. Augustine | Medical Matters
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.
  
  (Of the following statements pertaining to medical matters, sign only in accordance with your wishes.)
  
  Emergency Medical Treatement
  In the event of an emergency, I hereby give permission to Diocese of St. Augustine's employees, volunteers, or representatives to seek medical treatment for my child above named.
  
  In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Diocesan representatives or volunteers to hospitalize, secure proper treatment for, and order injection and/or anesthesia and/or surgery for my child above named.
  
  Medical Matters REQUIRED I Agree I Disagree Please fill out this field.
  
  Student Information 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Student's Email Please enter an email address.
  
  Student's Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Student's School REQUIRED Please fill out this field. Please enter valid data.
  
  Are you registering for the Blaze Girls Group? (The cost is $50 for the girl's kit) REQUIRED Yes No Need more information Please fill out this field.
  
  Student's T-Shirt Size REQUIRED Please fill out this field.
  
  Special Concerns CYM should be aware of:
  
  Medical Problems or Conditions (Allergies, Diabetes, etc.) & Symptoms
  
  RELEASE FORMS
  
  Diocese of St. Augustine | Child Photography Release
  
  Without compensation, I hereby grant permission to the Catholic Diocese of St. Augustine to use and reproduce photographs and/or video taken of my child. These photographs may be used for news and editorial purposes in publications and other electronic reproductions (websites and video, including livestream) and/or brochures.
  
  In addition, I grant my permission to alter the same photos without restriction and to copyright the same. I hereby release the photographer, the journalists and the publications or media outlets they represent, as well as, the parish/church and/or school involved, the Bishop of the Diocese of St. Augustine, a corporation sole, the Catholic Diocese of St. Augustine and all of their employees and agents, from all claims and liability relating to said photographs.
  Updated 8/2020
  
  Media Release REQUIRED I Agree I Disagree Please fill out this field.
  
  Diocese of St. Augustine | Medical Matters
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.
  
  (Of the following statements pertaining to medical matters, sign only in accordance with your wishes.)
  
  Emergency Medical Treatement
  In the event of an emergency, I hereby give permission to Diocese of St. Augustine's employees, volunteers, or representatives to seek medical treatment for my child above named.
  
  In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Diocesan representatives or volunteers to hospitalize, secure proper treatment for, and order injection and/or anesthesia and/or surgery for my child above named.
  
  Medical Matters REQUIRED I Agree I Disagree Please fill out this field.
  
  Student Information 7
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Student's Email Please enter an email address.
  
  Student's Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Student's School REQUIRED Please fill out this field. Please enter valid data.
  
  Are you registering for the Blaze Girls Group? (The cost is $50 for the girl's kit) REQUIRED Yes No Need more information Please fill out this field.
  
  Student's T-Shirt Size REQUIRED Please fill out this field.
  
  Special Concerns CYM should be aware of:
  
  Medical Problems or Conditions (Allergies, Diabetes, etc.) & Symptoms
  
  RELEASE FORMS
  
  Diocese of St. Augustine | Child Photography Release
  
  Without compensation, I hereby grant permission to the Catholic Diocese of St. Augustine to use and reproduce photographs and/or video taken of my child. These photographs may be used for news and editorial purposes in publications and other electronic reproductions (websites and video, including livestream) and/or brochures.
  
  In addition, I grant my permission to alter the same photos without restriction and to copyright the same. I hereby release the photographer, the journalists and the publications or media outlets they represent, as well as, the parish/church and/or school involved, the Bishop of the Diocese of St. Augustine, a corporation sole, the Catholic Diocese of St. Augustine and all of their employees and agents, from all claims and liability relating to said photographs.
  Updated 8/2020
  
  Media Release REQUIRED I Agree I Disagree Please fill out this field.
  
  Diocese of St. Augustine | Medical Matters
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.
  
  (Of the following statements pertaining to medical matters, sign only in accordance with your wishes.)
  
  Emergency Medical Treatement
  In the event of an emergency, I hereby give permission to Diocese of St. Augustine's employees, volunteers, or representatives to seek medical treatment for my child above named.
  
  In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Diocesan representatives or volunteers to hospitalize, secure proper treatment for, and order injection and/or anesthesia and/or surgery for my child above named.
  
  Medical Matters REQUIRED I Agree I Disagree Please fill out this field.
  
  Student Information 8
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Student's Email Please enter an email address.
  
  Student's Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Student's School REQUIRED Please fill out this field. Please enter valid data.
  
  Are you registering for the Blaze Girls Group? (The cost is $50 for the girl's kit) REQUIRED Yes No Need more information Please fill out this field.
  
  Student's T-Shirt Size REQUIRED Please fill out this field.
  
  Special Concerns CYM should be aware of:
  
  Medical Problems or Conditions (Allergies, Diabetes, etc.) & Symptoms
  
  RELEASE FORMS
  
  Diocese of St. Augustine | Child Photography Release
  
  Without compensation, I hereby grant permission to the Catholic Diocese of St. Augustine to use and reproduce photographs and/or video taken of my child. These photographs may be used for news and editorial purposes in publications and other electronic reproductions (websites and video, including livestream) and/or brochures.
  
  In addition, I grant my permission to alter the same photos without restriction and to copyright the same. I hereby release the photographer, the journalists and the publications or media outlets they represent, as well as, the parish/church and/or school involved, the Bishop of the Diocese of St. Augustine, a corporation sole, the Catholic Diocese of St. Augustine and all of their employees and agents, from all claims and liability relating to said photographs.
  Updated 8/2020
  
  Media Release REQUIRED I Agree I Disagree Please fill out this field.
  
  Diocese of St. Augustine | Medical Matters
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.
  
  (Of the following statements pertaining to medical matters, sign only in accordance with your wishes.)
  
  Emergency Medical Treatement
  In the event of an emergency, I hereby give permission to Diocese of St. Augustine's employees, volunteers, or representatives to seek medical treatment for my child above named.
  
  In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Diocesan representatives or volunteers to hospitalize, secure proper treatment for, and order injection and/or anesthesia and/or surgery for my child above named.
  
  Medical Matters REQUIRED I Agree I Disagree Please fill out this field.
  
  Student Information 9
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Student's Email Please enter an email address.
  
  Student's Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Student's School REQUIRED Please fill out this field. Please enter valid data.
  
  Are you registering for the Blaze Girls Group? (The cost is $50 for the girl's kit) REQUIRED Yes No Need more information Please fill out this field.
  
  Student's T-Shirt Size REQUIRED Please fill out this field.
  
  Special Concerns CYM should be aware of:
  
  Medical Problems or Conditions (Allergies, Diabetes, etc.) & Symptoms
  
  RELEASE FORMS
  
  Diocese of St. Augustine | Child Photography Release
  
  Without compensation, I hereby grant permission to the Catholic Diocese of St. Augustine to use and reproduce photographs and/or video taken of my child. These photographs may be used for news and editorial purposes in publications and other electronic reproductions (websites and video, including livestream) and/or brochures.
  
  In addition, I grant my permission to alter the same photos without restriction and to copyright the same. I hereby release the photographer, the journalists and the publications or media outlets they represent, as well as, the parish/church and/or school involved, the Bishop of the Diocese of St. Augustine, a corporation sole, the Catholic Diocese of St. Augustine and all of their employees and agents, from all claims and liability relating to said photographs.
  Updated 8/2020
  
  Media Release REQUIRED I Agree I Disagree Please fill out this field.
  
  Diocese of St. Augustine | Medical Matters
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.
  
  (Of the following statements pertaining to medical matters, sign only in accordance with your wishes.)
  
  Emergency Medical Treatement
  In the event of an emergency, I hereby give permission to Diocese of St. Augustine's employees, volunteers, or representatives to seek medical treatment for my child above named.
  
  In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Diocesan representatives or volunteers to hospitalize, secure proper treatment for, and order injection and/or anesthesia and/or surgery for my child above named.
  
  Medical Matters REQUIRED I Agree I Disagree Please fill out this field.
  
  Student Information 10
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Student's Email Please enter an email address.
  
  Student's Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Student's School REQUIRED Please fill out this field. Please enter valid data.
  
  Are you registering for the Blaze Girls Group? (The cost is $50 for the girl's kit) REQUIRED Yes No Need more information Please fill out this field.
  
  Student's T-Shirt Size REQUIRED Please fill out this field.
  
  Special Concerns CYM should be aware of:
  
  Medical Problems or Conditions (Allergies, Diabetes, etc.) & Symptoms
  
  RELEASE FORMS
  
  Diocese of St. Augustine | Child Photography Release
  
  Without compensation, I hereby grant permission to the Catholic Diocese of St. Augustine to use and reproduce photographs and/or video taken of my child. These photographs may be used for news and editorial purposes in publications and other electronic reproductions (websites and video, including livestream) and/or brochures.
  
  In addition, I grant my permission to alter the same photos without restriction and to copyright the same. I hereby release the photographer, the journalists and the publications or media outlets they represent, as well as, the parish/church and/or school involved, the Bishop of the Diocese of St. Augustine, a corporation sole, the Catholic Diocese of St. Augustine and all of their employees and agents, from all claims and liability relating to said photographs.
  Updated 8/2020
  
  Media Release REQUIRED I Agree I Disagree Please fill out this field.
  
  Diocese of St. Augustine | Medical Matters
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.
  
  (Of the following statements pertaining to medical matters, sign only in accordance with your wishes.)
  
  Emergency Medical Treatement
  In the event of an emergency, I hereby give permission to Diocese of St. Augustine's employees, volunteers, or representatives to seek medical treatment for my child above named.
  
  In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Diocesan representatives or volunteers to hospitalize, secure proper treatment for, and order injection and/or anesthesia and/or surgery for my child above named.
  
  Medical Matters REQUIRED I Agree I Disagree Please fill out this field.
  
  Parent/Guardian Information
  
  Is your family registered at St. Luke's? Yes No
  
  If no, list church name Please enter valid data.
  
  Are you interested in participating in the Adult Core Team? REQUIRED Yes No Need more information Please fill out this field.
  
  Have you taken "Protecting God's Children"? (Log on to Virtus.org to register) REQUIRED Yes No Please fill out this field.
  
  Have you had a Diocesan background check? REQUIRED Yes No Please fill out this field.
  
  Parent/Guardian #1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Relation to Student REQUIRED Please fill out this field.
  
  Parent/Guardian #2
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Relation to Student
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Adult Photography Release Form
  Diocese of St. Augustine
  Catholic Center
  11625 Old St. Augustine Rd.
  Jacksonville, Fl 32258
  
  Without compensation, I hereby grant permission to the Catholic Diocese of Saint Augustine to use and reproduce photographs taken of me.
  These photographs may be used for news and editorial purposes in publications, electronic reproductions (websites and video, including livestream) and/or brochures. In addition, I grant my permission to alter the same photos without restriction and to copyright the same.
  
  I hereby release the photographer, the journalists and the publications or media outlets they represent, as well as, the parish/church and/or school involved, the Bishop of the Diocese of St. Augustine, a corporation sole, the Catholic Diocese of Saint Augustine and all of their employees and agents, from all claims and liability relating to said photographs.
  Updated 8/2020
  
  I Agree Please select this field.
  
  Parent/Guardian Signature:
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date REQUIRED Please fill out this field. Please enter a date.
  
  Submit
  
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CYM Junior High Registration

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