St. Cecilia Youth Choir Registration Youth Choir Registration Number of Youth to Register for Choir1234Youth Number 1Youth Name* First Last School he/she attends* Grade (2019-2020 School Year)* Gender* male female Youth Number 2Youth Name* First Last School he/she attends* Grade (2019-2020 School Year)* Gender* male female Youth Number 3Youth Name* First Last School he/she attends* Grade (2019-2020 School Year)* Gender* male female Youth Number 4Youth Name* First Last School he/she attends* Grade (2019-2020 School Year)* Gender* male female Family InformationNames of Parents/Guardians* Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent's Email* Enter Email Confirm Email Home Phone*Mom's CellDad's CellMedical/LiabilityMedical Information and Liability Waiver*As the parent of the above mentioned youth, I hereby grant permission for my youth to be medically treated in case of sickness or accident. I understand and acknowledge that participation in the activities involves inherent risks of injury to my youth. I agree to indemnify the Parish, Choir Directors, Ministers, Volunteers, and the Diocese of Arlington for any costs or expenses arising out of my youth's participation in the activities including the cost of any medical care given my youth or any expenses or fees incurred in any lawsuit arising as a result of any damage or injuries caused by my child in the course of his/her participation in the activity. I further give my consent to that in my absence the above named minor be admitted to any hospital or medical facility for diagnosis and treatment. I request and authorize physicians, dentists, and staff, duly licensed as Doctors of Medicine or Doctors of Dentistry or other such licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of the above minor. I have not been given a guarantee as to the results of examination or treatment. I authorize the hospital or medical facility to dispose of any specimen or tissue taken from the above named minor. I agree Signature* Please type your name to digitally sign, acknowledging you have read and agree to the above listed waiver.Alternate Contact in Emergency (other than parent)* First Last Alternate Contact's Phone*Alternate Contact's Relationship to Youth* Known allergies, current medications, other medical conditions, or special needs While we ask for allergen information, these are informative only for necessary cases.MiscellaneousPhotographs*By clicking "I agree" and participating in any of the choir program's various activities, events, volunteer opportunities, etc., I authorize Holy Spirit to use my youth's picture or video recording for social/advertising purposes to include but not limited to the parish website, parish social media, and bulletin boards on church grounds. I agree Δ