Ascend Small Groups Registration - All Saints Youth Ministry

2024-2025 Ascend Registration

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Participant's Name:*

First Last

Are you already fully registered for this school year's Middle School Youth Ministry Program?*

Yes, I'm already registered for middle school ministry!

No, I'm not registered yet.

You must be fully registered for our current school year's middle school youth ministry program to participate in this program. Please CLICK HERE TO REGISTER. (opens a new window for you). You must be registered via that page first in order to complete this event registration.

Have you completed the Middle School Ministry registration linked above?*

Yes, I have completed middle school ministry registration.

No, I have not, and I understand I cannot register for this program until I do.

Date of Birth:*

Gender*

Male

Female

Middle School:*

High School Graduation Year:*

Address*

Street Address City State ZIP Code

Participant's Email:*

Enter Email Confirm Email

Participant's Phone:*

Emergency Contact Name:*

First Last

Emergency Contact Phone:*

Family Physician:

Physician Phone:

Please list any medical concerns (e.g. allergies) that your child has and that we need to be aware of:

List any medication your child will need administered during this event:

Please Agree to the Following

As parent/guardian I agree to indemnify the All Saints Parish, Youth Ministers, Volunteers, and the Diocese of Arlington for any costs or expenses arising out of my child’s participation in the outing described above, including the cost of any medical care given my child 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 or 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 authorize the All Saints Youth Ministry to use my child’s picture or video recording for educational and/or marketing purposes. Parents/guardians who do not wish their child to be photographed or filmed should so notify All Saints Youth Ministry in writing.

Parent/Guardian Signature:*

Please sign in the box above using your mouse (or your finger if you're on a tablet).

Print Your Name:*

Please Agree to the Following

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