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Youth Ministry
Totus Tuus – Registration is OPEN NOW!
May 18, 2022
|
News
,
PSR
,
Youth Ministry
Totus Tuus - June 2022
Register online for the upcoming Totus Tuus vacation bible school.
Parent/Guardian Name (Nombre de los padres/tudor)
(Required)
First
Last
Address (Dirección)
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
Phone (Teléfono)
(Required)
Phone (Teléfono celular)
Email (Correo electrónico)
Child/Children Information
(Required)
Child Name (Nombre de los ninos)
Grade in 2022-2023 (Grado en 2022-2023)
Add
Remove
Allergies or Medical Concerns for your child/children? (Alergias, medicinas y dosis, condiciones medicas, restricciones alimentarias)
ADDITIONAL EMERGENCY CONTACT INFORMATION (INFORMACIÓN ADICIONAL DE CONTACTO DE EMERGENCIA)
Name and phone number of an adult to reach in case of emergency in the event that you cannot be reached at the numbers above. -------------------- Nombre y teléfono de un adulto con quien podamos comunicarnos en una emergencia, en caso de que no podamos comunicarnos con usted(es) a los números que figuran en la parte superior.
Name (Nombre)
(Required)
First
Last
Phone (Teléfono)
(Required)
Name of Family Physician (Nombre del médico general)
(Required)
First
Last
Phone (Teléfono)
(Required)
Medical Authorization (Autorización médica)
I understand that the Catholic Diocese of Jefferson City and Totus Tuus assume no responsibility for accidents which may occur in association with diocesan events and activities. I agree to use my/our personal insurance to cover any such incidents. I understand that, in the event medical intervention is needed, every attempt will be made to contact the persons listed above. In the event those individuals cannot be reached, I/We hereby give permission to the physician or any other qualified medical staff selected by the event leader to hospitalize, secure medical treatment, and/or order injection, anesthesia, or surgery for Participant as deemed necessary. ------------------- Entiendo que la Diócesis Católica de Jefferson City y Totus Tuus no asumen ninguna responsabilidad por accidentes que pudieran ocurrir relacionados con eventos y actividades de la diócesis. Me comprometo a utilizar mi/nuestro seguro personal (aseguranza) para cubrir cualquiera de estos incidentes. Entiendo que, en el caso de necesidad de intervención médica, se hará todo lo posible para ponerse en comunicación con las personas indicadas en la parte superior. En caso de no lograr comunicarse con dichas personas, yo/nosotros doy/damos autorización al médico o cualquier otro personal médico calificado, seleccionado por el líder del evento, a hospitalizar, asegurar el tratamiento médico, u ordenar inyecciones, anestesia o cirugía para el participante, si lo considera necesario.
Permission for Other Medical Matters (Permiso para otros asuntos médicos)
(Required)
In the event it comes to the attention of the Diocesan and/or parish chaperones that my child complains of illness, I grant permission for non-prescription medication (such as Tylenol, lozenges, etc.) to be given to Participant. ---------------- En el caso de que los chaperones de la diócesis o parroquia se den cuenta de que mi niño se queja por estar enfermo, otorgo permiso para que se le dé medicamentos sin receta (como Tylenol, pastillas para la tos, etc.).
Yes (SÍ)
No
Release of Liability for Youth and Adults (Exoneración de responsabilidad de los jóvenes y adultos)
I understand all reasonable safety precautions will be taken at all times by the Catholic Diocese of Jefferson City and Totus Tuus and its employees and agents during the events and activities. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree to indemnify and hold harmless the Catholic Diocese and Totus Tuus, its leaders, employees and volunteer staff from any and all claims arising from or in connection with attending this event. -------------------- Entiendo que se tomarán todas las precauciones de seguridad razonables en todo momento por parte de la Diócesis Católica de Jefferson City y Totus Tuus y sus empleados y agentes durante los eventos y actividades. Entiendo la posibilidad de riesgos imprevistos y conozco la posibilidad inherente de riesgos. Estoy de acuerdo en exonerar y liberar de responsabilidad a la Diócesis Católica de Jefferson City Totus Tuus, sus dirigentes, empleados y voluntarios por cualquier reclamo que surja en relación con la asistencia a este evento.
Code of Behavior for Youth and Adults (Código de conducta para jóvenes y adultos)
I agree to abide by and/or instruct my child to abide by all rules and regulations as outlined by the aforementioned chaperones/representatives. I agree that if I/Participant fail(s) to abide in any way by the rules, that I/Participant can be dismissed from the event and sent home immediately at my/Participant’s expense with no right of reimbursement or refund for any amount in connection therewith from the Catholic Diocese of Jefferson City or its chaperones/representatives. ------------------- Acepto acatar e instruir a mi hijo a acatar todas las reglas y reglamentos expuestos por los mencionados chaperones/representantes. Estoy de acuerdo en que si el participante o yo no cumplimos en algún modo con las reglas, tanto el participante como yo podemos ser despedidos del evento y enviados a casa inmediatamente, con cargo a mi costo y el del participante, sin derecho a reintegro o devolución de ninguna cantidad en relación con ello, de parte de la Diócesis Católica de Jefferson City o sus chaperones o representantes.
Photo Release (Autorización para la toma de fotografías)
(Required)
I hereby authorize the Catholic Diocese of Jefferson City and Totus Tuus and its agents to utilize photographic and/or video images of me or my child by the Catholic Diocese of Jefferson City. In giving my consent, I hereby indemnify and hold harmless the Catholic Diocese of Jefferson City and Totus Tuus and its agents from any and all responsibility of liability. I understand that I will receive no compensation should any photograph and/or video of me or my child be used. ----------------------- Autorizo a la Diócesis Católica de Jefferson City y Totus Tuus y a sus agentes a utilizar fotografías o videos de mi hijo o míos. Al dar mi consentimiento, exonero y libero de toda responsabilidad a la Diócesis Católica de Jefferson City. Entiendo que no recibiré compensación en caso de que alguna fotografía o video de mi hijo o míos sean usados.
Yes (SÍ)
No
CAPTCHA
e-Signature (Firma electrónica del padre/tutor)
(Required)
By typing in your name you are verifying you completed this form and your name acts as your "eSignature." --------------------- Al escribir su nombre, está verificando que completó este formulario y su nombre actúa como su "firma electrónica".
Comments
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