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Registration via SmartWaiver for Holy Cross Youth Ministry is required. A separate waiver must be filled out for each child. We apologize for this inconvenience.

Once completed, please click "Agree To This Document" at the bottom.

Participant's
Minor
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First Minor's Name

First Name*

Middle Name

Last Name*
First Minor's Date of Birth*
I certify that I am 18 years of age or older
First Minor's Signature*
Minor's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
Minor's Information

School Attending for 2018-2019 School Year *
Grade Level for 2018-2019 School Year*

Child's Cell Phone Number (if they wish to receive YM updates)

Child's Email Address (if they wish to receive YM newsletters)
Are you/your child registered at Holy Cross?*
Yes
No

If no, what is your parish of registration?
Sacraments your child has received: (check all that apply) *
Baptism
First Holy Communion
Reconciliation
Confirmation
My child has a food allergy.*
No
Yes

If yes to food allergy, please list the type(s) here.
My child has a medical condition/disability the youth ministry staff should be aware of.*
No
Yes

If yes to medical condition/disability, please list/explain.

Please list any accommodations your child may need.
My child is allergic to certain medications.*
No
Yes

If yes to medication allergies, please list them here.
Emergency Contact and Phone Number

Emergency Contact's Name *

Emergency Contact's Phone Number *
Father/Primary Guardian's Information

First Name *

Last Name *

Address (if different from child)

Email Address (to receive YM updates and newsletters)

Cell Phone Number (to receive YM reminders and updates)
Mother/Primary Guardian's Information

First Name *

Last Name *

Address (if different from child)

Email Address (to receive YM updates and newsletters)

Cell Phone Number (to receive YM reminders and updates)
Custody/Divorce Situations
Are there any current situations youth ministry staff should be aware of regarding the safety of your child?*
No
Yes

If yes, please explain.
Is there anyone who is not permitted to be with or pick up your child?*
No
Yes

If yes, please explain.
Photo Release (via Diocese of Greensburg website)
I hereby grant the Diocese of Greensburg, Pennsylvania, and its respective licensees (Holy Cross), successors and assigns, the right and permission, with respect to those photographs taken of the minor named below on whose behalf I am signing, and with respect to any printed or electronic matter in connection therewith, to do the following: 1. To include such photographs on the Diocese of Greensburg (+Holy Cross) website and on print material. 2. To use my name, or the name of the minor on whose behalf I am signing, in connection with the foregoing.*
No
Yes
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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