High School Ministry Registration

TEEN

First Name REQUIRED Please fill out this field. Please enter valid data.

Middle Name (if applicable) Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Nickname Please enter valid data.

Age REQUIRED Please fill out this field. Please enter valid data.

Place of Birth (City, State) REQUIRED Please fill out this field. Please enter valid data.

Date of Birth REQUIRED Please fill out this field. Please enter valid data.

Street Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

SCHOOL INFORMATION

Name of School Please enter valid data.

Graduating Class Year 2020 2021 2022 2023

Marital Status of Parents Single Married by priest or deacon Married by Justice of the Peace Annulled Separated Divorced Remarried

MOTHER

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Maiden Name REQUIRED Please fill out this field. Please enter valid data.

E-mail Address REQUIRED Please fill out this field. Please enter valid data.

Cell Phone REQUIRED Please fill out this field. Please enter valid data.

FATHER

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Cell Phone REQUIRED Please fill out this field. Please enter valid data.

E-mail Address REQUIRED Please fill out this field. Please enter valid data.

BAPTISM INFORMATION

If the church of baptism is not St. Ambrose, a copy of the candidate’s baptismal certificate must be provided as part of this application. You can email a copy of the baptismal certificate or stop by and the office can copy it for you.

Date of Baptism REQUIRED Please fill out this field. Please enter valid data.

Church of Baptism REQUIRED

If you were baptized at a church other than St. Ambrose, we will need a copy of the baptismal certificate.

Please fill out this field. Please enter valid data.

Church of Baptism Location REQUIRED

If you were baptized at a church other than St. Ambrose, we will need a copy of the baptismal certificate.

Please fill out this field. Please enter valid data.

PERMISSION FOR PHOTOGRAPHS/VIDEOS

As the parent(s) listed above, I hereby authorize and give my consent for the taking of pictures (moving or still) of the above named teen and further give permission for their reproduction for: teaching purposes, news releases, social media, publications and/or community awareness.

I Agree Please select this field.

YOUTH CODE OF CONDUCT
This Code of Conduct is for use with youth under 18 years who serve as volunteers, participants or are in work placement in parishes or schools. Young people under 18 are not required to attend VIRTUS training and apply for a background check as a condition for their ministry or work. Adults responsible for the supervision of young people in ministry or work situations need to review this document with the young person and clarify/explain any part that may not be understood by the young person. This can be done in a group or individual meeting. This form is to be read and filled out by the young person, the parent/guardian, and the supervisor. The form will be kept in the parish or school. I promise to follow the rules and guidelines in this Code of Conduct. I understand that any action inconsistent with or failure to take action mandated by this Code of Conduct may result in my removal from my volunteer or work assignment.

As a youth participant, volunteer or worker I will:
• Safeguard children and other youth entrusted to my care at all times.
• Treat everyone with respect, loyalty, patience, integrity, courtesy and dignity.
• Take care to be positive, supportive, and caring in my speaking, writing, and interacting with children and youth.
• Avoid situations in ministry or work where I am alone with any child.
• Use positive reinforcement rather than criticism or comparison when working with children/youth.
• Cooperate fully in any investigation of abuse of children/youth. Report suspected abuse to my supervisor, or if it involves my supervisor, report it to the pastor/parish life director.
• Be aware that children/young people can easily become infatuated with a youth leader or an adult. If I sense this is happening, I will not encourage it. I will make my supervisor aware of it so that he/she can resolve the matter, including
reassigning me to other activities.
• Maintain appropriate physical and emotional boundaries with children/youth.
• Dress modestly and appropriately and not wear any clothing with offensive messages or pictures while exercising my ministry or working.

As a youth participant, volunteer or worker I will not:

• Endorse, during my ministry, any view contrary to the teachings of the Catholic Church.
• Commit an illegal or immoral act.
• Smoke or use tobacco products in the presence of minors.
• Use, possess or be under the influence of alcohol or illegal drugs at anytime while at work or volunteering.
• Verbally threaten or physically abuse anyone.
• Use profanity in the presence of any child, youth or adult.
• Use discipline that frightens or humiliates a child/youth.
• Touch a child/youth in a sexual, overly affectionate or other inappropriate manner.
• Place myself in a situation where my interactions with a child/youth would not be visible to others.
• Accept gifts from or give gifts to children/youth in my care without approval from my supervisor.
• Tolerate inappropriate or bullying behavior by a child/youth towards another child/youth.
• Communicate with minors in my charge about matters unrelated to my responsibilities within ministry.

By checking the box below, I agree that, along with my parent(s) I, have read and understand the Roman Catholic Diocese of Albany Code of Conduct for Youth Workers and Volunteers and will honor them while at work or as a volunteer. Both my parents and I understand and agree that the parent/guardian will be notified at the time of any infraction requiring dismissal from work or volunteer assignment at the parish or school where the young person is working or ministering.

I Agree Please select this field.

Medical Information

Allergies

Dietary Restrictions

Any physical limitations or special medical conditions?

Insurance Provider Please enter valid data.

Policy Number Please enter valid data.

Primary policy holder Please enter valid data.

IN CASE OF EMERGENCY and I cannot be reached please notify:

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter valid data.

Payment select - REQUIRED Please fill out this field.

High School Ministry Registration

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