Spring Break: Staycation

I grant permission for my Junior High student to attend the Spring Break Staycation event(s). I understand that if my Junior High student breaks any of the rules found in the Youth Ministry Handbook or misbehaves in a manner that any of the chaperones deem inappropriate, I will be contacted to pick up my Junior High student from the Spring Break Staycation event(s).

I agree to speak to my Junior High student about behaving and being prudent with taking photos of others and posting them on social media prior to attending the Spring Break Staycation event(s).

I understand that it is my responsibility to have the necessary Archdiocesan forms on file at the Youth Office.

I understand that Christ the King Youth Ministry is part of the Parish and though it works in accordance with Christ the King School, Christ the King Youth Ministry is its own entity. All reports, questions and concerns need to be made known to Antonio Guzman, Youth Director, not the Christ the King School Administration.

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above. REQUIRED Acknowledgement of statements above. Please fill out this field.

Parent/Guardian Electronic Signature REQUIRED Please fill out this field. Please enter valid data.

Date REQUIRED Please fill out this field. Please enter a date.

Email REQUIRED Please fill out this field. Please enter an email address.

Will you be a chaperone for the event(s)? REQUIRED Yes No Please fill out this field.

Number of Students being Registered REQUIRED Please fill out this field.
Student 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.
- Grade REQUIRED Please fill out this field.
- Allergies/Medical Conditions
- Which days will your child attend? REQUIRED
  15.0 – March 15 - Zoo
  30.0 – March 16 - Science Museum and Cathedral
  30.0 – March 17 - Main Event & Tour of Shrine Please fill out this field.
Student 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.
- Grade REQUIRED Please fill out this field.
- Allergies/Medical Conditions
- Which days will your child attend? REQUIRED
  15.0 – March 15 - Zoo
  30.0 – March 16 - Science Museum and Cathedral
  30.0 – March 17 - Main Event & Tour of Shrine Please fill out this field.
Student 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.
- Grade REQUIRED Please fill out this field.
- Allergies/Medical Conditions
- Which days will your child attend? REQUIRED
  15.0 – March 15 - Zoo
  30.0 – March 16 - Science Museum and Cathedral
  30.0 – March 17 - Main Event & Tour of Shrine Please fill out this field.
Student 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.
- Grade REQUIRED Please fill out this field.
- Allergies/Medical Conditions
- Which days will your child attend? REQUIRED
  15.0 – March 15 - Zoo
  30.0 – March 16 - Science Museum and Cathedral
  30.0 – March 17 - Main Event & Tour of Shrine Please fill out this field.

I grant CK Youth Office staff/chaperones permission for my student(s) to be pictured and to use those pictures for Social Media, website, yearbook and other public platforms. REQUIRED Grant Permission Deny Permission Please fill out this field.

Name of Emergency Contact REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Phone Number REQUIRED Please fill out this field. Please enter a phone number.

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