Required registration for St. Jude Youth Ministry Open Gym this year.

If you have any questions, please contact Heather Warner at [email protected].

Please enter Parent/Guardian contact Information

Medical Information

Insurance Information

Emergency Information

In the event of an emergency, if you are unable to reach me at the above numbers, contact:

Consent to Participate*
I consent to the participation of my CHILD/WARD in the above named ACTIVITY. In consideration for my CHILD/WARD’s participation, I agree to reimburse and indemnify the PARISH (understood to include The Archdiocese of Milwaukee) for all reasonable legal and court fees incurred by PARISH in defending a lawsuit that I or my CHILD/WARD may bring against the PARISH which relates to the above named ACTIVITY if the PARISH is found not legally liable by the courts and prevails in the lawsuit. If the PARISH is found legally liable for injuries sustained by CHILD/WARD, this paragraph will not apply.

I certify that I have an understanding of this agreement and any risks and hazards associated with the ACTIVITY described above that my CHILD/WARD will be participating in. I further understand that I had the opportunity to fully discuss this agreement with a representative of the PARISH to clarify any concerns or questions about the ACTIVITY or this agreement that I may have had.

Please check below to electronically sign this form.