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Junior High and High School CYM Registration

- The maximum number of form submissions has been reached. This form is currently not available.
  
  Welcome to CYM! We are so excited to have your student(s) join us for the 2025-2026 school year.
  
  Our Youth Ministry is active all year long with weekly meetings, various special events, retreats and service opportunities. Throughout the school year we meet on Wednesday evenings from 6:00 - 8:00 pm.
  
  There is no fee to be a part of CYM, but we do ask that each family provides at least one meal during the year for a Wednesday night meeting. You can find the link below the registration link on the youth ministry page of this website.
  
  If you would rather offer a gift card to help pay for a meal, we suggest at least $60.00. Gift cards to Papa Johns, Little Caesars, Chick Fil A, Walmart or Publix are all very helpful.
  
  Thank you so much for sharing your student(s) with us. It's going to be an amazing year centered around our Eucharistic Lord. May God bless our youth and their families abundantly.
  
  Saint Carlo Acutis.................pray for us!
  
  Family Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Primary Family Cell Number REQUIRED Please fill out this field. Please enter valid data.
  
  Receive Text Message Notifications REQUIRED Yes No Please fill out this field.
  
  Primary Family Email REQUIRED Please fill out this field. Please enter valid data.
  
  Number of Students REQUIRED Please fill out this field.
  
  Student Information 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Do we have permission to text your student directly with information and activities pertaining to CYM? Yes No
  
  Student's Email Please enter an email address.
  
  Do we have permission to email your student directly with information and activities pertaining to CYM ? Yes No
  
  Student's Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Student's School REQUIRED Please fill out this field. Please enter valid data.
  
  If your student is of high school age, would they like to be on the teen core team and attend every Wednesday? REQUIRED Yes No I am registering a Jr. High Student Please fill out this field.
  
  Would you prefer to provide a meal or a gift card for a Wednesday Night Meeting? REQUIRED Meal Gift Card Please fill out this field.
  
  Special Concerns CYM should be aware of:
  
  Medical Problems or Conditions (Allergies, Diabetes, etc.) & Symptoms
  
  RELEASE FORMS
  
  Diocese of St. Augustine |Photography and Media Release Form for Minor Children
  
  Without compensation, I hereby grant the Catholic Diocese of St. Augustine (the “Diocese of St. Augustine”), its ministries, parishes, schools and other affiliated entities, permission to record my child’s appearance, physical likeness and/or voice on videotape, on film, or digital video disk, or other means, and/or take photographs of my child. Notwithstanding any prohibition as may be contained in Section 540.08, Florida Statutes, I hereby freely and voluntarily
  consent to the use, reproduction, and distribution of photographs, video recordings or other media capturing my child’s image, physical likeness, or voice for an indefinite period of time or until such time I expressly revoke my consent in writing. These materials may include, but are not limited to news, editorial content, publications, promotional materials, electronic
  media (websites, social media channels, podcasts, videos), and/or printed brochures.
  In addition, I understand and agree that:
  * The Diocese of St. Augustine, its ministries, parishes, schools, and other affiliated entities may alter, edit or modify these materials as needed, without restriction.
  * The Diocese of St. Augustine retains the sole ownership and right to copyright any such materials.
  * My consent is voluntary, and I waive any rights to inspect or approve the finished products or the specific use of such
  materials.
  
  I agree to hold the Diocese of St. Augustine, the Bishop of the Diocese of St. Augustine, its employees and agents, and any media outlet or representatives involved in the creation of distribution of the materials harmless against claim, liability, loss, or damage caused by, or arising from any claims, demands or liability arising from or related the creation, use, production, or distribution of these materials. This Photography and Media Release Form for Minor Children is binding and applies to any claims of defamation, invasion of privacy, or rights of publicity. I have read this Photography and Media Release Form for Minor Children before signing and fully understand the contents, meaning, and impact of this release. I understand that I am free to address any specific questions and have done so prior to signing this release.
  
  Diocese of St. Augustine Catholic Center Last updated: 2/6/25
  Address: 11625 Old St. Augustine Road, Jacksonville, FL 32258
  Phone: (904) 262-3200
  
  Media Release REQUIRED I Agree I Disagree Please fill out this field.
  
  Diocese of St. Augustine | Medical Matters
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.
  
  (Of the following statements pertaining to medical matters, sign only in accordance with your wishes.)
  
  Emergency Medical Treatement
  In the event of an emergency, I hereby give permission to Diocese of St. Augustine's employees, volunteers, or representatives to seek medical treatment for my child above named.
  
  In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Diocesan representatives or volunteers to hospitalize, secure proper treatment for, and order injection and/or anesthesia and/or surgery for my child above named.
  
  Medical Matters REQUIRED I Agree I Disagree Please fill out this field.
  
  Student Information 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Do we have permission to text your student directly with information and activities pertaining to CYM? Yes No
  
  Student's Email Please enter an email address.
  
  Do we have permission to email your student directly with information and activities pertaining to CYM ? Yes No
  
  Student's Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Student's School REQUIRED Please fill out this field. Please enter valid data.
  
  If your student is of high school age, would they like to be on the teen core team and attend every Wednesday? REQUIRED Yes No I am registering a Jr. High Student Please fill out this field.
  
  Would you prefer to provide a meal or a gift card for a Wednesday Night Meeting? REQUIRED Meal Gift Card Please fill out this field.
  
  Special Concerns CYM should be aware of:
  
  Medical Problems or Conditions (Allergies, Diabetes, etc.) & Symptoms
  
  RELEASE FORMS
  
  Diocese of St. Augustine |Photography and Media Release Form for Minor Children
  
  Without compensation, I hereby grant the Catholic Diocese of St. Augustine (the “Diocese of St. Augustine”), its ministries, parishes, schools and other affiliated entities, permission to record my child’s appearance, physical likeness and/or voice on videotape, on film, or digital video disk, or other means, and/or take photographs of my child. Notwithstanding any prohibition as may be contained in Section 540.08, Florida Statutes, I hereby freely and voluntarily
  consent to the use, reproduction, and distribution of photographs, video recordings or other media capturing my child’s image, physical likeness, or voice for an indefinite period of time or until such time I expressly revoke my consent in writing. These materials may include, but are not limited to news, editorial content, publications, promotional materials, electronic
  media (websites, social media channels, podcasts, videos), and/or printed brochures.
  In addition, I understand and agree that:
  * The Diocese of St. Augustine, its ministries, parishes, schools, and other affiliated entities may alter, edit or modify these materials as needed, without restriction.
  * The Diocese of St. Augustine retains the sole ownership and right to copyright any such materials.
  * My consent is voluntary, and I waive any rights to inspect or approve the finished products or the specific use of such
  materials.
  
  I agree to hold the Diocese of St. Augustine, the Bishop of the Diocese of St. Augustine, its employees and agents, and any media outlet or representatives involved in the creation of distribution of the materials harmless against claim, liability, loss, or damage caused by, or arising from any claims, demands or liability arising from or related the creation, use, production, or distribution of these materials. This Photography and Media Release Form for Minor Children is binding and applies to any claims of defamation, invasion of privacy, or rights of publicity. I have read this Photography and Media Release Form for Minor Children before signing and fully understand the contents, meaning, and impact of this release. I understand that I am free to address any specific questions and have done so prior to signing this release.
  
  Diocese of St. Augustine Catholic Center Last updated: 2/6/25
  Address: 11625 Old St. Augustine Road, Jacksonville, FL 32258
  Phone: (904) 262-3200
  
  Media Release REQUIRED I Agree I Disagree Please fill out this field.
  
  Diocese of St. Augustine | Medical Matters
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.
  
  (Of the following statements pertaining to medical matters, sign only in accordance with your wishes.)
  
  Emergency Medical Treatement
  In the event of an emergency, I hereby give permission to Diocese of St. Augustine's employees, volunteers, or representatives to seek medical treatment for my child above named.
  
  In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Diocesan representatives or volunteers to hospitalize, secure proper treatment for, and order injection and/or anesthesia and/or surgery for my child above named.
  
  Medical Matters REQUIRED I Agree I Disagree Please fill out this field.
  
  Student Information 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Do we have permission to text your student directly with information and activities pertaining to CYM? Yes No
  
  Student's Email Please enter an email address.
  
  Do we have permission to email your student directly with information and activities pertaining to CYM ? Yes No
  
  Student's Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Student's School REQUIRED Please fill out this field. Please enter valid data.
  
  If your student is of high school age, would they like to be on the teen core team and attend every Wednesday? REQUIRED Yes No I am registering a Jr. High Student Please fill out this field.
  
  Would you prefer to provide a meal or a gift card for a Wednesday Night Meeting? REQUIRED Meal Gift Card Please fill out this field.
  
  Special Concerns CYM should be aware of:
  
  Medical Problems or Conditions (Allergies, Diabetes, etc.) & Symptoms
  
  RELEASE FORMS
  
  Diocese of St. Augustine |Photography and Media Release Form for Minor Children
  
  Without compensation, I hereby grant the Catholic Diocese of St. Augustine (the “Diocese of St. Augustine”), its ministries, parishes, schools and other affiliated entities, permission to record my child’s appearance, physical likeness and/or voice on videotape, on film, or digital video disk, or other means, and/or take photographs of my child. Notwithstanding any prohibition as may be contained in Section 540.08, Florida Statutes, I hereby freely and voluntarily
  consent to the use, reproduction, and distribution of photographs, video recordings or other media capturing my child’s image, physical likeness, or voice for an indefinite period of time or until such time I expressly revoke my consent in writing. These materials may include, but are not limited to news, editorial content, publications, promotional materials, electronic
  media (websites, social media channels, podcasts, videos), and/or printed brochures.
  In addition, I understand and agree that:
  * The Diocese of St. Augustine, its ministries, parishes, schools, and other affiliated entities may alter, edit or modify these materials as needed, without restriction.
  * The Diocese of St. Augustine retains the sole ownership and right to copyright any such materials.
  * My consent is voluntary, and I waive any rights to inspect or approve the finished products or the specific use of such
  materials.
  
  I agree to hold the Diocese of St. Augustine, the Bishop of the Diocese of St. Augustine, its employees and agents, and any media outlet or representatives involved in the creation of distribution of the materials harmless against claim, liability, loss, or damage caused by, or arising from any claims, demands or liability arising from or related the creation, use, production, or distribution of these materials. This Photography and Media Release Form for Minor Children is binding and applies to any claims of defamation, invasion of privacy, or rights of publicity. I have read this Photography and Media Release Form for Minor Children before signing and fully understand the contents, meaning, and impact of this release. I understand that I am free to address any specific questions and have done so prior to signing this release.
  
  Diocese of St. Augustine Catholic Center Last updated: 2/6/25
  Address: 11625 Old St. Augustine Road, Jacksonville, FL 32258
  Phone: (904) 262-3200
  
  Media Release REQUIRED I Agree I Disagree Please fill out this field.
  
  Diocese of St. Augustine | Medical Matters
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.
  
  (Of the following statements pertaining to medical matters, sign only in accordance with your wishes.)
  
  Emergency Medical Treatement
  In the event of an emergency, I hereby give permission to Diocese of St. Augustine's employees, volunteers, or representatives to seek medical treatment for my child above named.
  
  In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Diocesan representatives or volunteers to hospitalize, secure proper treatment for, and order injection and/or anesthesia and/or surgery for my child above named.
  
  Medical Matters REQUIRED I Agree I Disagree Please fill out this field.
  
  Student Information 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Do we have permission to text your student directly with information and activities pertaining to CYM? Yes No
  
  Student's Email Please enter an email address.
  
  Do we have permission to email your student directly with information and activities pertaining to CYM ? Yes No
  
  Student's Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Student's School REQUIRED Please fill out this field. Please enter valid data.
  
  If your student is of high school age, would they like to be on the teen core team and attend every Wednesday? REQUIRED Yes No I am registering a Jr. High Student Please fill out this field.
  
  Would you prefer to provide a meal or a gift card for a Wednesday Night Meeting? REQUIRED Meal Gift Card Please fill out this field.
  
  Special Concerns CYM should be aware of:
  
  Medical Problems or Conditions (Allergies, Diabetes, etc.) & Symptoms
  
  RELEASE FORMS
  
  Diocese of St. Augustine |Photography and Media Release Form for Minor Children
  
  Without compensation, I hereby grant the Catholic Diocese of St. Augustine (the “Diocese of St. Augustine”), its ministries, parishes, schools and other affiliated entities, permission to record my child’s appearance, physical likeness and/or voice on videotape, on film, or digital video disk, or other means, and/or take photographs of my child. Notwithstanding any prohibition as may be contained in Section 540.08, Florida Statutes, I hereby freely and voluntarily
  consent to the use, reproduction, and distribution of photographs, video recordings or other media capturing my child’s image, physical likeness, or voice for an indefinite period of time or until such time I expressly revoke my consent in writing. These materials may include, but are not limited to news, editorial content, publications, promotional materials, electronic
  media (websites, social media channels, podcasts, videos), and/or printed brochures.
  In addition, I understand and agree that:
  * The Diocese of St. Augustine, its ministries, parishes, schools, and other affiliated entities may alter, edit or modify these materials as needed, without restriction.
  * The Diocese of St. Augustine retains the sole ownership and right to copyright any such materials.
  * My consent is voluntary, and I waive any rights to inspect or approve the finished products or the specific use of such
  materials.
  
  I agree to hold the Diocese of St. Augustine, the Bishop of the Diocese of St. Augustine, its employees and agents, and any media outlet or representatives involved in the creation of distribution of the materials harmless against claim, liability, loss, or damage caused by, or arising from any claims, demands or liability arising from or related the creation, use, production, or distribution of these materials. This Photography and Media Release Form for Minor Children is binding and applies to any claims of defamation, invasion of privacy, or rights of publicity. I have read this Photography and Media Release Form for Minor Children before signing and fully understand the contents, meaning, and impact of this release. I understand that I am free to address any specific questions and have done so prior to signing this release.
  
  Diocese of St. Augustine Catholic Center Last updated: 2/6/25
  Address: 11625 Old St. Augustine Road, Jacksonville, FL 32258
  Phone: (904) 262-3200
  
  Media Release REQUIRED I Agree I Disagree Please fill out this field.
  
  Diocese of St. Augustine | Medical Matters
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.
  
  (Of the following statements pertaining to medical matters, sign only in accordance with your wishes.)
  
  Emergency Medical Treatement
  In the event of an emergency, I hereby give permission to Diocese of St. Augustine's employees, volunteers, or representatives to seek medical treatment for my child above named.
  
  In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Diocesan representatives or volunteers to hospitalize, secure proper treatment for, and order injection and/or anesthesia and/or surgery for my child above named.
  
  Medical Matters REQUIRED I Agree I Disagree Please fill out this field.
  
  Student Information 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Do we have permission to text your student directly with information and activities pertaining to CYM? Yes No
  
  Student's Email Please enter an email address.
  
  Do we have permission to email your student directly with information and activities pertaining to CYM ? Yes No
  
  Student's Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Student's School REQUIRED Please fill out this field. Please enter valid data.
  
  If your student is of high school age, would they like to be on the teen core team and attend every Wednesday? REQUIRED Yes No I am registering a Jr. High Student Please fill out this field.
  
  Would you prefer to provide a meal or a gift card for a Wednesday Night Meeting? REQUIRED Meal Gift Card Please fill out this field.
  
  Special Concerns CYM should be aware of:
  
  Medical Problems or Conditions (Allergies, Diabetes, etc.) & Symptoms
  
  RELEASE FORMS
  
  Diocese of St. Augustine |Photography and Media Release Form for Minor Children
  
  Without compensation, I hereby grant the Catholic Diocese of St. Augustine (the “Diocese of St. Augustine”), its ministries, parishes, schools and other affiliated entities, permission to record my child’s appearance, physical likeness and/or voice on videotape, on film, or digital video disk, or other means, and/or take photographs of my child. Notwithstanding any prohibition as may be contained in Section 540.08, Florida Statutes, I hereby freely and voluntarily
  consent to the use, reproduction, and distribution of photographs, video recordings or other media capturing my child’s image, physical likeness, or voice for an indefinite period of time or until such time I expressly revoke my consent in writing. These materials may include, but are not limited to news, editorial content, publications, promotional materials, electronic
  media (websites, social media channels, podcasts, videos), and/or printed brochures.
  In addition, I understand and agree that:
  * The Diocese of St. Augustine, its ministries, parishes, schools, and other affiliated entities may alter, edit or modify these materials as needed, without restriction.
  * The Diocese of St. Augustine retains the sole ownership and right to copyright any such materials.
  * My consent is voluntary, and I waive any rights to inspect or approve the finished products or the specific use of such
  materials.
  
  I agree to hold the Diocese of St. Augustine, the Bishop of the Diocese of St. Augustine, its employees and agents, and any media outlet or representatives involved in the creation of distribution of the materials harmless against claim, liability, loss, or damage caused by, or arising from any claims, demands or liability arising from or related the creation, use, production, or distribution of these materials. This Photography and Media Release Form for Minor Children is binding and applies to any claims of defamation, invasion of privacy, or rights of publicity. I have read this Photography and Media Release Form for Minor Children before signing and fully understand the contents, meaning, and impact of this release. I understand that I am free to address any specific questions and have done so prior to signing this release.
  
  Diocese of St. Augustine Catholic Center Last updated: 2/6/25
  Address: 11625 Old St. Augustine Road, Jacksonville, FL 32258
  Phone: (904) 262-3200
  
  Media Release REQUIRED I Agree I Disagree Please fill out this field.
  
  Diocese of St. Augustine | Medical Matters
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.
  
  (Of the following statements pertaining to medical matters, sign only in accordance with your wishes.)
  
  Emergency Medical Treatement
  In the event of an emergency, I hereby give permission to Diocese of St. Augustine's employees, volunteers, or representatives to seek medical treatment for my child above named.
  
  In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Diocesan representatives or volunteers to hospitalize, secure proper treatment for, and order injection and/or anesthesia and/or surgery for my child above named.
  
  Medical Matters REQUIRED I Agree I Disagree Please fill out this field.
  
  Student Information 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Do we have permission to text your student directly with information and activities pertaining to CYM? Yes No
  
  Student's Email Please enter an email address.
  
  Do we have permission to email your student directly with information and activities pertaining to CYM ? Yes No
  
  Student's Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Student's School REQUIRED Please fill out this field. Please enter valid data.
  
  If your student is of high school age, would they like to be on the teen core team and attend every Wednesday? REQUIRED Yes No I am registering a Jr. High Student Please fill out this field.
  
  Would you prefer to provide a meal or a gift card for a Wednesday Night Meeting? REQUIRED Meal Gift Card Please fill out this field.
  
  Special Concerns CYM should be aware of:
  
  Medical Problems or Conditions (Allergies, Diabetes, etc.) & Symptoms
  
  RELEASE FORMS
  
  Diocese of St. Augustine |Photography and Media Release Form for Minor Children
  
  Without compensation, I hereby grant the Catholic Diocese of St. Augustine (the “Diocese of St. Augustine”), its ministries, parishes, schools and other affiliated entities, permission to record my child’s appearance, physical likeness and/or voice on videotape, on film, or digital video disk, or other means, and/or take photographs of my child. Notwithstanding any prohibition as may be contained in Section 540.08, Florida Statutes, I hereby freely and voluntarily
  consent to the use, reproduction, and distribution of photographs, video recordings or other media capturing my child’s image, physical likeness, or voice for an indefinite period of time or until such time I expressly revoke my consent in writing. These materials may include, but are not limited to news, editorial content, publications, promotional materials, electronic
  media (websites, social media channels, podcasts, videos), and/or printed brochures.
  In addition, I understand and agree that:
  * The Diocese of St. Augustine, its ministries, parishes, schools, and other affiliated entities may alter, edit or modify these materials as needed, without restriction.
  * The Diocese of St. Augustine retains the sole ownership and right to copyright any such materials.
  * My consent is voluntary, and I waive any rights to inspect or approve the finished products or the specific use of such
  materials.
  
  I agree to hold the Diocese of St. Augustine, the Bishop of the Diocese of St. Augustine, its employees and agents, and any media outlet or representatives involved in the creation of distribution of the materials harmless against claim, liability, loss, or damage caused by, or arising from any claims, demands or liability arising from or related the creation, use, production, or distribution of these materials. This Photography and Media Release Form for Minor Children is binding and applies to any claims of defamation, invasion of privacy, or rights of publicity. I have read this Photography and Media Release Form for Minor Children before signing and fully understand the contents, meaning, and impact of this release. I understand that I am free to address any specific questions and have done so prior to signing this release.
  
  Diocese of St. Augustine Catholic Center Last updated: 2/6/25
  Address: 11625 Old St. Augustine Road, Jacksonville, FL 32258
  Phone: (904) 262-3200
  
  Media Release REQUIRED I Agree I Disagree Please fill out this field.
  
  Diocese of St. Augustine | Medical Matters
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.
  
  (Of the following statements pertaining to medical matters, sign only in accordance with your wishes.)
  
  Emergency Medical Treatement
  In the event of an emergency, I hereby give permission to Diocese of St. Augustine's employees, volunteers, or representatives to seek medical treatment for my child above named.
  
  In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Diocesan representatives or volunteers to hospitalize, secure proper treatment for, and order injection and/or anesthesia and/or surgery for my child above named.
  
  Medical Matters REQUIRED I Agree I Disagree Please fill out this field.
  
  Student Information 7
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Do we have permission to text your student directly with information and activities pertaining to CYM? Yes No
  
  Student's Email Please enter an email address.
  
  Do we have permission to email your student directly with information and activities pertaining to CYM ? Yes No
  
  Student's Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Student's School REQUIRED Please fill out this field. Please enter valid data.
  
  If your student is of high school age, would they like to be on the teen core team and attend every Wednesday? REQUIRED Yes No I am registering a Jr. High Student Please fill out this field.
  
  Would you prefer to provide a meal or a gift card for a Wednesday Night Meeting? REQUIRED Meal Gift Card Please fill out this field.
  
  Special Concerns CYM should be aware of:
  
  Medical Problems or Conditions (Allergies, Diabetes, etc.) & Symptoms
  
  RELEASE FORMS
  
  Diocese of St. Augustine |Photography and Media Release Form for Minor Children
  
  Without compensation, I hereby grant the Catholic Diocese of St. Augustine (the “Diocese of St. Augustine”), its ministries, parishes, schools and other affiliated entities, permission to record my child’s appearance, physical likeness and/or voice on videotape, on film, or digital video disk, or other means, and/or take photographs of my child. Notwithstanding any prohibition as may be contained in Section 540.08, Florida Statutes, I hereby freely and voluntarily
  consent to the use, reproduction, and distribution of photographs, video recordings or other media capturing my child’s image, physical likeness, or voice for an indefinite period of time or until such time I expressly revoke my consent in writing. These materials may include, but are not limited to news, editorial content, publications, promotional materials, electronic
  media (websites, social media channels, podcasts, videos), and/or printed brochures.
  In addition, I understand and agree that:
  * The Diocese of St. Augustine, its ministries, parishes, schools, and other affiliated entities may alter, edit or modify these materials as needed, without restriction.
  * The Diocese of St. Augustine retains the sole ownership and right to copyright any such materials.
  * My consent is voluntary, and I waive any rights to inspect or approve the finished products or the specific use of such
  materials.
  
  I agree to hold the Diocese of St. Augustine, the Bishop of the Diocese of St. Augustine, its employees and agents, and any media outlet or representatives involved in the creation of distribution of the materials harmless against claim, liability, loss, or damage caused by, or arising from any claims, demands or liability arising from or related the creation, use, production, or distribution of these materials. This Photography and Media Release Form for Minor Children is binding and applies to any claims of defamation, invasion of privacy, or rights of publicity. I have read this Photography and Media Release Form for Minor Children before signing and fully understand the contents, meaning, and impact of this release. I understand that I am free to address any specific questions and have done so prior to signing this release.
  
  Diocese of St. Augustine Catholic Center Last updated: 2/6/25
  Address: 11625 Old St. Augustine Road, Jacksonville, FL 32258
  Phone: (904) 262-3200
  
  Media Release REQUIRED I Agree I Disagree Please fill out this field.
  
  Diocese of St. Augustine | Medical Matters
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.
  
  (Of the following statements pertaining to medical matters, sign only in accordance with your wishes.)
  
  Emergency Medical Treatement
  In the event of an emergency, I hereby give permission to Diocese of St. Augustine's employees, volunteers, or representatives to seek medical treatment for my child above named.
  
  In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Diocesan representatives or volunteers to hospitalize, secure proper treatment for, and order injection and/or anesthesia and/or surgery for my child above named.
  
  Medical Matters REQUIRED I Agree I Disagree Please fill out this field.
  
  Student Information 8
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Do we have permission to text your student directly with information and activities pertaining to CYM? Yes No
  
  Student's Email Please enter an email address.
  
  Do we have permission to email your student directly with information and activities pertaining to CYM ? Yes No
  
  Student's Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Student's School REQUIRED Please fill out this field. Please enter valid data.
  
  If your student is of high school age, would they like to be on the teen core team and attend every Wednesday? REQUIRED Yes No I am registering a Jr. High Student Please fill out this field.
  
  Would you prefer to provide a meal or a gift card for a Wednesday Night Meeting? REQUIRED Meal Gift Card Please fill out this field.
  
  Special Concerns CYM should be aware of:
  
  Medical Problems or Conditions (Allergies, Diabetes, etc.) & Symptoms
  
  RELEASE FORMS
  
  Diocese of St. Augustine |Photography and Media Release Form for Minor Children
  
  Without compensation, I hereby grant the Catholic Diocese of St. Augustine (the “Diocese of St. Augustine”), its ministries, parishes, schools and other affiliated entities, permission to record my child’s appearance, physical likeness and/or voice on videotape, on film, or digital video disk, or other means, and/or take photographs of my child. Notwithstanding any prohibition as may be contained in Section 540.08, Florida Statutes, I hereby freely and voluntarily
  consent to the use, reproduction, and distribution of photographs, video recordings or other media capturing my child’s image, physical likeness, or voice for an indefinite period of time or until such time I expressly revoke my consent in writing. These materials may include, but are not limited to news, editorial content, publications, promotional materials, electronic
  media (websites, social media channels, podcasts, videos), and/or printed brochures.
  In addition, I understand and agree that:
  * The Diocese of St. Augustine, its ministries, parishes, schools, and other affiliated entities may alter, edit or modify these materials as needed, without restriction.
  * The Diocese of St. Augustine retains the sole ownership and right to copyright any such materials.
  * My consent is voluntary, and I waive any rights to inspect or approve the finished products or the specific use of such
  materials.
  
  I agree to hold the Diocese of St. Augustine, the Bishop of the Diocese of St. Augustine, its employees and agents, and any media outlet or representatives involved in the creation of distribution of the materials harmless against claim, liability, loss, or damage caused by, or arising from any claims, demands or liability arising from or related the creation, use, production, or distribution of these materials. This Photography and Media Release Form for Minor Children is binding and applies to any claims of defamation, invasion of privacy, or rights of publicity. I have read this Photography and Media Release Form for Minor Children before signing and fully understand the contents, meaning, and impact of this release. I understand that I am free to address any specific questions and have done so prior to signing this release.
  
  Diocese of St. Augustine Catholic Center Last updated: 2/6/25
  Address: 11625 Old St. Augustine Road, Jacksonville, FL 32258
  Phone: (904) 262-3200
  
  Media Release REQUIRED I Agree I Disagree Please fill out this field.
  
  Diocese of St. Augustine | Medical Matters
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.
  
  (Of the following statements pertaining to medical matters, sign only in accordance with your wishes.)
  
  Emergency Medical Treatement
  In the event of an emergency, I hereby give permission to Diocese of St. Augustine's employees, volunteers, or representatives to seek medical treatment for my child above named.
  
  In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Diocesan representatives or volunteers to hospitalize, secure proper treatment for, and order injection and/or anesthesia and/or surgery for my child above named.
  
  Medical Matters REQUIRED I Agree I Disagree Please fill out this field.
  
  Student Information 9
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Do we have permission to text your student directly with information and activities pertaining to CYM? Yes No
  
  Student's Email Please enter an email address.
  
  Do we have permission to email your student directly with information and activities pertaining to CYM ? Yes No
  
  Student's Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Student's School REQUIRED Please fill out this field. Please enter valid data.
  
  If your student is of high school age, would they like to be on the teen core team and attend every Wednesday? REQUIRED Yes No I am registering a Jr. High Student Please fill out this field.
  
  Would you prefer to provide a meal or a gift card for a Wednesday Night Meeting? REQUIRED Meal Gift Card Please fill out this field.
  
  Special Concerns CYM should be aware of:
  
  Medical Problems or Conditions (Allergies, Diabetes, etc.) & Symptoms
  
  RELEASE FORMS
  
  Diocese of St. Augustine |Photography and Media Release Form for Minor Children
  
  Without compensation, I hereby grant the Catholic Diocese of St. Augustine (the “Diocese of St. Augustine”), its ministries, parishes, schools and other affiliated entities, permission to record my child’s appearance, physical likeness and/or voice on videotape, on film, or digital video disk, or other means, and/or take photographs of my child. Notwithstanding any prohibition as may be contained in Section 540.08, Florida Statutes, I hereby freely and voluntarily
  consent to the use, reproduction, and distribution of photographs, video recordings or other media capturing my child’s image, physical likeness, or voice for an indefinite period of time or until such time I expressly revoke my consent in writing. These materials may include, but are not limited to news, editorial content, publications, promotional materials, electronic
  media (websites, social media channels, podcasts, videos), and/or printed brochures.
  In addition, I understand and agree that:
  * The Diocese of St. Augustine, its ministries, parishes, schools, and other affiliated entities may alter, edit or modify these materials as needed, without restriction.
  * The Diocese of St. Augustine retains the sole ownership and right to copyright any such materials.
  * My consent is voluntary, and I waive any rights to inspect or approve the finished products or the specific use of such
  materials.
  
  I agree to hold the Diocese of St. Augustine, the Bishop of the Diocese of St. Augustine, its employees and agents, and any media outlet or representatives involved in the creation of distribution of the materials harmless against claim, liability, loss, or damage caused by, or arising from any claims, demands or liability arising from or related the creation, use, production, or distribution of these materials. This Photography and Media Release Form for Minor Children is binding and applies to any claims of defamation, invasion of privacy, or rights of publicity. I have read this Photography and Media Release Form for Minor Children before signing and fully understand the contents, meaning, and impact of this release. I understand that I am free to address any specific questions and have done so prior to signing this release.
  
  Diocese of St. Augustine Catholic Center Last updated: 2/6/25
  Address: 11625 Old St. Augustine Road, Jacksonville, FL 32258
  Phone: (904) 262-3200
  
  Media Release REQUIRED I Agree I Disagree Please fill out this field.
  
  Diocese of St. Augustine | Medical Matters
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.
  
  (Of the following statements pertaining to medical matters, sign only in accordance with your wishes.)
  
  Emergency Medical Treatement
  In the event of an emergency, I hereby give permission to Diocese of St. Augustine's employees, volunteers, or representatives to seek medical treatment for my child above named.
  
  In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Diocesan representatives or volunteers to hospitalize, secure proper treatment for, and order injection and/or anesthesia and/or surgery for my child above named.
  
  Medical Matters REQUIRED I Agree I Disagree Please fill out this field.
  
  Student Information 10
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Do we have permission to text your student directly with information and activities pertaining to CYM? Yes No
  
  Student's Email Please enter an email address.
  
  Do we have permission to email your student directly with information and activities pertaining to CYM ? Yes No
  
  Student's Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Student's School REQUIRED Please fill out this field. Please enter valid data.
  
  If your student is of high school age, would they like to be on the teen core team and attend every Wednesday? REQUIRED Yes No I am registering a Jr. High Student Please fill out this field.
  
  Would you prefer to provide a meal or a gift card for a Wednesday Night Meeting? REQUIRED Meal Gift Card Please fill out this field.
  
  Special Concerns CYM should be aware of:
  
  Medical Problems or Conditions (Allergies, Diabetes, etc.) & Symptoms
  
  RELEASE FORMS
  
  Diocese of St. Augustine |Photography and Media Release Form for Minor Children
  
  Without compensation, I hereby grant the Catholic Diocese of St. Augustine (the “Diocese of St. Augustine”), its ministries, parishes, schools and other affiliated entities, permission to record my child’s appearance, physical likeness and/or voice on videotape, on film, or digital video disk, or other means, and/or take photographs of my child. Notwithstanding any prohibition as may be contained in Section 540.08, Florida Statutes, I hereby freely and voluntarily
  consent to the use, reproduction, and distribution of photographs, video recordings or other media capturing my child’s image, physical likeness, or voice for an indefinite period of time or until such time I expressly revoke my consent in writing. These materials may include, but are not limited to news, editorial content, publications, promotional materials, electronic
  media (websites, social media channels, podcasts, videos), and/or printed brochures.
  In addition, I understand and agree that:
  * The Diocese of St. Augustine, its ministries, parishes, schools, and other affiliated entities may alter, edit or modify these materials as needed, without restriction.
  * The Diocese of St. Augustine retains the sole ownership and right to copyright any such materials.
  * My consent is voluntary, and I waive any rights to inspect or approve the finished products or the specific use of such
  materials.
  
  I agree to hold the Diocese of St. Augustine, the Bishop of the Diocese of St. Augustine, its employees and agents, and any media outlet or representatives involved in the creation of distribution of the materials harmless against claim, liability, loss, or damage caused by, or arising from any claims, demands or liability arising from or related the creation, use, production, or distribution of these materials. This Photography and Media Release Form for Minor Children is binding and applies to any claims of defamation, invasion of privacy, or rights of publicity. I have read this Photography and Media Release Form for Minor Children before signing and fully understand the contents, meaning, and impact of this release. I understand that I am free to address any specific questions and have done so prior to signing this release.
  
  Diocese of St. Augustine Catholic Center Last updated: 2/6/25
  Address: 11625 Old St. Augustine Road, Jacksonville, FL 32258
  Phone: (904) 262-3200
  
  Media Release REQUIRED I Agree I Disagree Please fill out this field.
  
  Diocese of St. Augustine | Medical Matters
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.
  
  (Of the following statements pertaining to medical matters, sign only in accordance with your wishes.)
  
  Emergency Medical Treatement
  In the event of an emergency, I hereby give permission to Diocese of St. Augustine's employees, volunteers, or representatives to seek medical treatment for my child above named.
  
  In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Diocesan representatives or volunteers to hospitalize, secure proper treatment for, and order injection and/or anesthesia and/or surgery for my child above named.
  
  Medical Matters REQUIRED I Agree I Disagree Please fill out this field.
  
  Parent/Guardian Information
  
  Is your family registered at St. Luke's? Yes No
  
  If no, please list church name. Please enter valid data.
  
  Are you interested in volunteering with our youth ministry? REQUIRED Yes No Maybe, I would like more information Please fill out this field.
  
  Areas to Volunteer - Please check where you interested in helping Weekly Meetings - Small groups leaders, meals, topics, etc. Fundraisers - Breakfasts, Bingo, Wreath Across America. etc. Special Events - Dances, Dinners, etc - Parish Wide Service Projects - Wreaths Across America, Parish events, Meals, Community Outreach Days, etc
  
  Have you taken "Protecting God's Children"? (Log on to Virtus.org to register) REQUIRED Yes No Please fill out this field.
  
  Have you had a Diocesan background check? REQUIRED Yes No Please fill out this field.
  
  Parent/Guardian #1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Relation to Student REQUIRED Please fill out this field.
  
  Parent/Guardian #2
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Relation to Student
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Adult Photography Release Form
  Diocese of St. Augustine
  Catholic Center
  11625 Old St. Augustine Rd.
  Jacksonville, Fl 32258
  
  Without compensation, I hereby grant the Catholic Diocese of St. Augustine (the “Diocese of St. Augustine”), its ministries, parishes, schools and other affiliated entities, permission to record my appearance, physical likeness and/or voice on videotape, on film, or digital video disk, or other means, and/or take photographs of my appearance. Notwithstanding any prohibition as may be contained in Section 540.08, Florida Statutes, I hereby freely and voluntarily consent to the use, reproduction, and distribution of photographs, video recordings or other media capturing my image, physical likeness, or voice for an indefinite period of time or until such time I expressly revoke my consent in writing. These materials may include, but are not limited to news, editorial content, publications, promotional materials, electronic media (websites, social media channels, podcasts, videos), and/or printed brochures.
  In addition, I understand and agree that:
  * The Diocese of St. Augustine, its ministries, parishes, schools, and other affiliated entities may alter, edit or modify these materials as needed, without restriction.
  * The Diocese of St. Augustine retains the sole ownership and right to copyright any such materials.
  * My consent is voluntary, and I waive any rights to inspect or approve the finished products or the specific use of such materials.
  I agree to hold the Diocese of St. Augustine, the Bishop of the Diocese of St. Augustine, its employees and agents, and any media outlet or representatives involved in the creation of distribution of the materials harmless against claim, liability, loss, or damage caused by, or arising from any claims, demands or liability arising from or related the creation, use, production, or distribution of these materials. This Photography and Media Release Form for Adults is binding and applies to any claims of defamation, invasion of privacy, or rights of publicity. I have read this Photography and Media Release Form for Adults before signing and fully understand the contents, meaning, and impact of this release. I understand that I am free to address any specific questions and have done so prior to signing this release.
  
  Last updated: 2/6/25
  
  I Agree Please select this field.
  
  Parent/Guardian Signature:
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date REQUIRED Please fill out this field. Please enter a date.
  
  Submit

Junior High and High School CYM Registration

RELEASE FORMS

RELEASE FORMS

RELEASE FORMS

RELEASE FORMS

RELEASE FORMS

RELEASE FORMS

RELEASE FORMS

RELEASE FORMS

RELEASE FORMS

RELEASE FORMS