Youth Ministry Registration — Saint Rose Philippine Duchesne

Fields marked * are required. We use Flocknote for communication — you and your teen will receive emails/texts from “mail@flocknote.com”; this is not junk mail. It is important we have the teen's, the mother's, and the father's email and phone. Staff and core team never contact teens from personal cell phones.

Schedule

Middle School (Grades 6–8) — Sundays 9:15am–10:45am
High School (Grades 9–12) — Sundays 12:15pm–1:45pm
Every teen is welcome to participate in our youth ministry activities.

Family Information

Family Last Name *

Mother / Guardian 1

Name

Address

City / Zip Code

Cell Phone

Father / Guardian 2

Name

Address (if different)

City / Zip Code

Cell Phone

Emergency Contact

Whom may we call in an emergency if parents cannot be reached? This should not be one of the parents' numbers.

Name

Phone Number

Relation

Teens / Children

Add one card per teen (up to 4). Sacramental Preparation (Reconciliation or Confirmation/First Eucharist) carries an additional $60 fee per child — check the box on the card if enrolling this year.

Photo Permission

Photos are taken throughout the year during classes and retreats and may be posted on our private Facebook page, social media, and/or the bulletin.

Yes, I give permission No

Indemnity Agreement *

As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above-named minor(s). I agree on behalf of myself, my child(ren) named herein, or our heirs, successors and assigns, to hold harmless and defend St. Rose Philippine Duchesne, its teachers, CRE, employees and agents, and the Diocese of Phoenix, its employees, agents, chaperons, or representatives associated with youth ministry, from any claim arising from or in connection with my child(ren) attending or in connection therewith. I agree to compensate St. Rose Philippine Duchesne, its teachers, directors, and agents, and the Diocese of Phoenix, its employees and agents and chaperons, or representatives associated with Youth Ministry 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 St. Rose Philippine Duchesne or the Diocese of Phoenix.

I have read and agree to the Indemnity Agreement above.

Parent / Guardian Signature * (type your full name)

Date *

Typing your full name above serves as your electronic signature.

Volunteer Interests for Daily or Weekend Mass

We encourage every student to take an active role in serving at the liturgy. Check any roles the teen would like to learn more about — we provide training and support.

Transportation of Minor to / from Church Campus

The Catholic Diocese of Phoenix “Policy on Sexual Misconduct,” as it pertains to Diocesan personnel, states: “Field trips or other outings involving a minor in places and situations where no other responsible adults are present are to be avoided.” Whenever minors are transported to or from parish programs or events, two responsible adults should accompany them in the vehicle.

Due to the limited number of participants in the St. Rose Youth Program and the times at which events occur, it may not always be feasible to have two adults in every vehicle. Exceptions are allowed when the parish has made reasonable efforts to provide a second adult without success, and the parent or guardian has provided written consent below.

Choose one * (1) Consent to allow for exception to policy. I consent to allow the student named below to travel to and from program events in a vehicle occupied by a single adult person at any time during the current school year. (2) Assumption of transportation responsibility. I will solely provide transportation for my child to all activities away from the Church campus.

Name of Parent / Guardian

Name of Student

Signature (type full name)

Printed Name of Parent / Guardian

Date

Safe Environment Training (SET) Acknowledgment

St. Rose Philippine Duchesne, the Mission of the Good Shepherd, and the Roman Catholic Diocese of Phoenix are deeply committed to providing a safe environment for all children. It is imperative that all children enrolled in a youth ministry program learn about ways to sustain and foster a safe environment for everyone.

On Sunday, August 23rd, Safe Environment Training (SET) will be offered to your teen. Middle School @ 9:15am / High School @ 12:15pm.

All youth who will volunteer at Masses and events on campus are required to complete this teaching.

Please confirm one * My child(ren) will attend the scheduled Safe Environment youth group. My child(ren) will be absent from the Safe Environment lesson for other reasons. I confirm that I will review this information with my child(ren) and complete the required Diocese forms by the required date.

Parent / Guardian Name

Signature (type full name)

Date

Each teen's name, age, grade, and program (from the cards above) are included with this acknowledgment.

Fee Estimate

Registration fee (0 teens @ $100)$0

Sacramental Preparation (0 children @ $60)$0

Estimated Total$0

This is an estimate. The suggested registration fee is $100 per teen — but no one is turned away due to cost. Sacramental Preparation (Reconciliation or Confirmation/First Eucharist) adds $60 per child. We are happy to work with each family individually.

Pay Online →

If you are unable to pay online, or need a fee waiver, please contact Chris Bosn in the parish office at 623-465-9740 ext. 102 or chrisbosn@stroseanthem.com.

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