Youth Registration

Youth Ministry Registration

Junior High & High School (Grades 6-12)

Mission Statement

St. Pius X Youth Ministry is committed to enabling youth to be the leaders of our Church. We affirm the gifts of our youth and foster opportunity to share these gifts with the larger community. The spiritual and social needs of the youth are to be met with the guidance and support of our leadership team in order to grow together in Christian faith.

Location

St. Pius X Youth Center which is located on the St. Pius X campus.

Classes Begin

Classes start September 10, 2024 (Middle School) or September 11, 2024 (High School).

Middle school- Tuesday 6:30-8:00 PM

High School- Wednesday 6:30-8:00 PM

Contact

Youth Ministry Coordinator

Teresa Twichel

406-200-2427 (call or text)

teresa@stpiusxblgs.org

Family Information

Father's Name *

Mother's Name *

Street Address *

City *

State *

ZIP *

Check here if this is a new addressYes

Are you Catholic? *

Are you registered members of St. Pius X Parish? *

If there are two households, please fill in the other parent's mailing address below.

Name

Street Address

City

State

ZIP

Are both households to receive mailings?YesNo

Phone Numbers & Email Addresses

Father's Cell

Text RemindersYesNo

Mother's Cell

Text RemindersYesNo

Father's Work

Mother's Work

Home Phone

Father's Email

Mother's Email

Emergency Contact

Name *

Relationship to Youth *

Home or Cell Phone *

Alternate Phone

Youth

Name *

Youth Cell

Date of Birth *

Age *

Grade *

School *

Sacraments ReceivedBaptism (Catholic)ConfirmationFirst EucharistChoose all applicable options

T-Shirt Size

Specific Medical Information: The following information will be held in confidence and will only be shared for the safety and wellbeing of your child.

Allergic Reactions (medications, foods, plants, insects, etc.)

Behaviorial Concerns

Physical Limitations

Does your child have a medically prescribed diet? If so, please describe:

Date of last tetanus/diphtheria immunization

Is your child subject to chronic homesickness, emotional reactions to new situations, sleepwalking, bedwetting, fainting?

Please list any other special medical conditions your child may have:

Student Medical Information Cont.

Emergency Medical Treatment *I consent (please check).In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor.

Family Doctor *

Doctor's Phone Number *

Family Health Plan Carrier *

Policy Number *

Other Medical Treatment *I understand (please check).In the event it comes to the attention of the parish, school, or Diocese of Great Falls-Billings, their officers, directors, agents, chaperones, or representatives associated with the activity that my child becomes ill with symptoms such as headache, vomiting, sore throat, fever, or diarrhea, I will be called.

Medications *Yes, my child takes a medication and I understand the medication instructions.N/AMy child is taking medications at present. My child will bring all such medications necessary and such medications will be well-labeled. All prescription medications will be in original prescription packaging. Names of all medications and concise directions for seeing that the child takes such medications, including dosage and frequency of dosage are attached to the prescription.

No MedicationsYes, I agree with this statement.N/ANo medication of any type whether prescription or non-prescription, may be administered to my child unless the situation is life-threatening and emergency treatment is required.

Non-prescription Medication *Yes, I agree with this statement.No, I do not agree with this statement.I hereby grant permission for non-prescription medication to be given to my child, if deemed appropriate.

Parent/Guardian Signature *

Date *

Indemnity Agreement

Consent Form *Yes, I agree (please check).As a parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above-named minor (“participant”). I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend all Catholic Parishes and Catholic Schools of the Diocese of Great Falls-Billings, their officers, directors, employees and agents, and the Diocese of Great Falls/Billings its employees and agents, chaperones, or representatives associated with the event, from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the parish/school, its officers, directors and agents, and the Diocese of Great Falls-Billings, its employees and agents and chaperones, or representatives associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the parish/school or the Diocese of Great Falls-Billings.

Parent/Guardian Signature *

Photo Permission *Yes, I grant permission.Yes, I grant permission for group photos only.No, I do not grant permission for any photos.I here by grant St. Pius X Catholic Church permission to publish photographs, videos, or audio recording in which the above named student(s) appears, while participating in any program associated with St. Pius X on its website, Facebook, bulletin, or other publication. No names will be attached to the photos. You may change your decision at any time by notifying the office.

Parental Involvement

August 2024 - May 2025

Throughout the year there will be events that need volunteers and your witness to the youth by giving your time will not go unnoticed by them even if they don't say anything. Please consider volunteering with our youth ministry this year. There will be opportunities to volunteer as often as on a weekly basis or as little as once throughout the year.

Please reach out to me about opportunities to volunteer.I cannot volunteer at this time.

Youth Ministry Fee

$15/child

Please follow the Parish Soft Giving page for payment. The fund name is "Youth Ministry Registration."

*scholarships available upon requests

I'm very excited for this year and the opportunity to walk with all the youth as they grow in discipleship and community.

-Teresa

Youth Ministry Registration

Junior High & High School (Grades 6-12)

Need Information?