Registration If you would rather print out the parental permission and consent to treat form click here. DIOCESE OF HARRISBURGOFFICE FOR YOUTH AND YOUNG ADULT MINISTRYPARENTAL PERMISSION AND CONSENT TO TREAT Participant's InformationParticipant's Name* First Last Birth Date* Age*Grade*Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code ParishSchool*Parent/Guardian's InformationParent/Guardian's Name* First Last Address (if different that participant) Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code E-mail Address* Primary Phone*Secondary PhoneI,Name of parent or guardian*, grant persmission forParticipant's Name Lynne Weis* Errorto participate in the 2024 St. Joe Softball season where she will travel by car, van or bus to practices, games or tournaments.I understand that the program will have competent adult supervision and reasonable and appropriate measures will be made to minimize the risk of injury and/or accident. I understand and have been informed that taking part in this youth trip or event involves the risk of injury.I hereby grant consent for the coach, chaperone, and/or adult volunteer under whose auspices the program is conducted, to secure all necessary emergency medical care and/or treatment that may be necessary for my child during the entire youth trip/event including any necessary transportation, if provided by the coach, chaperone, or adult volunteer. I release and hold harmless any said coach, chaperone, or adult volunteer, from any liability, who in good faith is placed in a position requiring decisions to be made for emergency care or medical treatment of the above-named young person. In case of accident, injury or loss, neither my family nor I will hold the diocese, the parish, the place where the event is conducted, the group sponsoring the event, nor any person or affiliate organization associated with the event responsible or liable.In the event of an emergency, if you are unable to reach me at the above number, contact:Name and Relationship* Primary Phone*Secondary PhoneFamily Physician* Phone*Allergic reactions (medications, food, insects, etc)*Medication(s) currently be taking*My child has special medical/mental conditions*YesNoIf Yes, please describe belowInsurance Company*Policy Number*Signature*Date* Relationship to Participant*St. Joseph Softball Spring Registration- Single Player, $110 discounted until March 1, 2024. $120 after March 1, 2024 This iframe contains the logic required to handle Ajax powered Gravity Forms.