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CHRIST THE KING CATHOLIC PARISH, OFFICE OF YOUTH MINISTRY Phone: (251) 626-3992 Sarah Wiese, Edge Director Office: 812 Trione Avenue [email protected] [email protected] www.ctkdaphne.org/edge
2018-19 EDGE REGISTRATION FORM Student Name: _____________________________________________________________________________
Birthday: _______ / ________ / _______ “I prefer to be called: ___________________________________”
Home Phone: _____________________________Student Cell Phone: ______________________________
School: _______________________________________________________ Grade: ______________________
Do you enjoy (check all that apply):
Singing What groups have you sung with? _____________________________________________
Playing an instrument Which one(s)? __________________________________________
Acting What have you been in? _______________________________________________
Painting Drawing Sculpting Making posters Writing
Photography Videography Other: _______________________________________
List any groups, athletic teams, or extracurricular activities that you are involved with during the
school year: ________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Circle all sacraments you have already received:
Baptism First Reconciliation First Communion Confirmation
Circle the Saturday/Sunday Mass you and/or your family regularly attend:
5:30 pm (Sat.) 7:00 am 8:30 am 11:00 am Youth Mass: 5:00 pm
Are you interested in altar serving for the Youth Mass this year? (circle one) YES NO
PARENT CONTACT INFORMATION
Parent 1 Name: _________________________________________ Relationship: ______________________
Email: _________________________________________________Phone: ______________________________
Parent 2 Name: _________________________________________ Relationship: ______________________
Email: _________________________________________________Phone: ______________________________
EMERGENCY CONTACT (please list an individual other than any appearing above.)
Name: ____________________________________________________________________________________
Relationship to Student: _________________________________ Phone: ____________________________
2018 CTK EDGE PARENT INVOLVEMENT FORM
Parent Name(s):_____________________________________________________________________________
Student Name(s):____________________________________________________________________________
Primary Parent Email:________________________________________________________________________
Phone: (____________)_______________________________________
Child Protection Policy dictates that we must have adults chaperoning each of our events.
We ask each family to volunteer for at least two of the following dates. Please check all dates
and ways your family plans to be involved. You will be contacted with details as the specific
events approach. Thank you in advance!
September 5—Wednesday
6th Grade Welcome Night (6:30-8:00pm)
Provide dessert
Chaperone
September 12—Wednesday
Fall Kick Off: Paint War (6:00-8:00pm)
Provide dessert
Chaperone
September 19—Wednesday
7/8th Grade Edge Night (6:30-8:00pm)
Provide dessert
Chaperone
October 3—Wednesday
6th Grade Edge Night (6:30-8:00 pm)
Provide dessert
Chaperone
October 17—Wednesday
7/8th Grade Edge Night (6:30-8:00pm)
Provide dessert
Chaperone
October 24—Wednesday
Laser Tag at Eastern Shore Lanes (6:00-8:00pm)
Chaperone
October 27—Saturday
Make a Difference Day (times dependent upon available service projects)
Service Project Leader
Chaperone
November 7—Wednesday
6th Grade Edge Night (6:30-8:00pm)
Provide dessert
Chaperone
November 14—Wednesday
Fall Service Project (6:30-8:00pm)
Provide dessert
Chaperone
November 16—Friday
Edge Game Night in the Gym (6:00-8:00pm)
Chaperone
November 28—Wednesday
7/8th Grade Edge Night (6:30-8:00pm)
Provide dessert
Chaperone
December 5—Wednesday
Advent Night of Service (6:30-8:00pm)
Provide dessert
Chaperone
SAVE THESE DATES The following events will require additional support, so separate sign-ups will be sent.
• November 11: Pie and Dessert Sale Fundraiser (CTK Gym)
• December 19: Christmas Dance Party (CTK Gym)
Be sure to make a copy for your records, then turn this sheet in to the parish or youth ministry
office as soon as possible! Thank you for making our program not only successful, but possible!
Sincerely, Sarah Wiese
CHRIST THE KING YOUTH MINISTRY
ELECTRONIC COMMUNICATION AND PHOTOGRAPHY WAIVER This form should be filled out once at the beginning of a student’s participation in both Edge and Life Teen.
Dear Parent or Legal Guardian,
We at Christ the King Life Teen and Edge are committed to ensuring proper and professional means of
communication with our youth in order to keep them informed and updated with all necessary
information. All interactions with youth via Social Media or other web-based platforms are monitored by
at least two adults of the parish and are strictly ministry related. Please complete and sign the below
waiver to provide us with permission to contact your child through electronic forms of communication.
Electronic Communication Release
______ I authorize Christ the King Life Teen or Edge to contact my child via Social Media and other
web-based platforms including Facebook, Instagram, email, and group text for information
regarding our youth program.
______ I do NOT authorize Christ the King Life Teen or Edge to contact my child via Social Media and
other web-based platforms.
Photography Release
Social Media is often used as a platform to share photos and videos from many of our events and
activities. Photographs of Life Teen and Edge events are also published in the King’s Herald and
sometimes the Catholic Week. When publishing photographs on the web, we do not identify the child by
name. Please complete and sign the below waiver to provide us with permission to publish your child’s
photograph through appropriate outlets.
______ I authorize Christ the King Life Teen or Edge to publish photographs taken of my child at events
and activities on Social Media, web- based platforms or additional outlets.
______ I do NOT authorize Christ the King Life Teen or Edge to publish photographs taken of my child
at events and activities on Social Media, web- based platforms or additional outlets.
Child 1 Name _______________________________________________ Grade: __________
Child 2 Name _______________________________________________ Grade: __________
Child 3 Name _______________________________________________ Grade: __________
Address: ______________________________________________________________________
City: ________________________________State: ____________ Zip:________________
Email: ________________________________________________________________________
Parent/ Guardian Name Print: ___________________________________
Parent/ Guardian Signature : ___________________________________Date: _____________________
MEDICAL INFORMATION FORM Participant: _______________________________________________ Date of Birth: _______________ Parent/Guardian: ___________________________________________ Phone:_____________________ Address: ________________________________________________________________________________ In the event of an emergency, if you are unable to reach me at the above number, contact: Emergency contact name (please print):________________________________________________________ Relationship to participant:__________________________________________________________________ Cell Phone:___________________________________ Other Phone: ______________________________ Family doctor: _________________________________ Phone: _________________________________ Family Health Plan Carrier: _________________________ Policy #: ______________________________ Signature: ____________________________________________________ Date: ____________________ Emergency Medical Treatment: In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. Parent/Guardian Signature ______________________________________________________________ Other Medical Treatment: (Please read carefully, sign all that pertain to your child.) In the event it comes to the attention of the parish/school/institution, its officers, directors and agents, and the Archdiocese of Mobile, chaperones, or representatives associated with the activity that my child becomes ill with symptoms such as headache, vomiting, sore throat, fever, diarrhea, I want to be called. Parent/Guardian Signature ______________________________________________________________ I hereby grant permission for non-prescription medication (such as non-aspirin products, i.e. acetaminophen or ibuprofen, throat lozenges, cough syrup) to be given to my child, if deemed appropriate. Parent/Guardian Signature ______________________________________________________________ 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. Parent/Guardian Signature ______________________________________________________________
Appendix 2
This Medical Information Form should be completed annually. It is the responsibility of the parent/guardian to inform the school or parish of any changes in the child’s medical condition during the year.
MEDICAL INFORMATION FORM (Continued)
Specific Medical Information: The school/parish will take reasonable care to see that the following information will be held in confidence: Medications: My child is taking medication at present. My child will bring all such medications necessary, and such medications will be well-labeled. Names of medications and concise directions for seeing that the child takes such medications, including dosage and frequency of dosage, are as follows: ______________________________________________________________________________________ ______________________________________________________________________________________ I hereby grant permission for the listed medications to be taken by my child on the trip, if necessary. Parent/Guardian Signature ______________________________________________________________ Allergic reactions (medications, foods, plants, insects, etc.): _______________________________________ Immunizations: Date of last tetanus/diphtheria immunization: _____________________________________ Does child have a medically prescribed diet? ___________________________________________________ If yes, what is it?__________________________________________________________________________ Does child have any physical or other limitations? _______________________________________________ Is child subject to chronic homesickness, emotional reactions to new situations, sleepwalking, bed-wetting, fainting? ________________________________________________________________________________ Has child recently been exposed to contagious disease or conditions, such as mumps, measles, chicken pox, flu, etc.? ________ If yes, list date and disease or condition: ______________________________________ ________________________________________________________________________________________ Additional special medical conditions of my child: ______________________________________________ ________________________________________________________________________________________ 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. Parent/Guardian Signature ________________________ Date ________________________
Appendix 2
