Middle School Youth Ministry Permission Form

This is the online Middle School Youth Ministry Permission form for June 1, 2025 to May 31, 2026 for our regularly scheduled activities.

This year-long permission form for Middle School Youth Ministry is for our regularly scheduled activities in the timeframe listed. Activities include Sunday meetings, weekday events, and other supervised activities customarily associated with the youth group, such as youth events and offsite service opportunities. Please complete and submit the online form below. Thank you!

Family Last Name REQUIRED Please fill out this field. Please enter valid data.

Father's Name Please enter valid data.

Mother's Name Please enter valid data.

Street Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Home Phone Number Please enter a phone number.

Dad's Cell Phone Number Please enter a phone number.

Mom's Cell Phone Number Please enter a phone number.

Primary Email REQUIRED Please fill out this field. Please enter an email address.

Are you a registered member of Good Shepherd? REQUIRED Yes No Please fill out this field.

How many middle schoolers would you like to register for our Middle School Youth Ministry? Please fill out this field.
Name of Middle Schooler 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.
- Grade Level (as of fall of 2025) REQUIRED Please fill out this field. Please enter an integer (number).
- School District REQUIRED Please fill out this field. Please enter valid data.
- Sex
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Transportation Permission
  
  I give permission for my child(ren) to be transported to and from regularly scheduled youth ministry activities by SafeParish-certified adults. I understand that by RSVPing for my child(ren) for a regularly scheduled offsite event, all permissions granted by this form apply to said event.
- I have read the Transportation Permission section of this form listed above, and.... REQUIRED Yes, I give permission for transportation as stated above. No, I do not give permission for transportation as stated above. Please fill out this field.
- Cell Phone Communication Permission
- I give permission for Good Shepherd Youth Ministry to contact my child via cell phone using Flocknote. REQUIRED Yes, I give permission for my child(ren) to be contacted on their cell phone using Flocknote. No, I do not give permission for my child(ren) to be contacted on their cell phone using Flocknote. Please fill out this field.
- If you answered "YES" to your child receiving messages on their cell phone via Flocknote, please provide the cell number. Please enter valid data.
- Please list allergies (e.g. food, drugs, anesthetics). If this does not apply, please write "NA." REQUIRED Please fill out this field.
- Please list medications taken regularly. If this does not apply, please write "NA." REQUIRED Please fill out this field.
- Please list any conditions/impairments (e.g. epilepsy, diabetes, asthma). If this does not apply, please write "NA." REQUIRED Please fill out this field.
Name of Middle Schooler 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.
- Grade Level (as of fall of 2025) REQUIRED Please fill out this field. Please enter an integer (number).
- School District REQUIRED Please fill out this field. Please enter valid data.
- Sex
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Transportation Permission
  
  I give permission for my child(ren) to be transported to and from regularly scheduled youth ministry activities by SafeParish-certified adults. I understand that by RSVPing for my child(ren) for a regularly scheduled offsite event, all permissions granted by this form apply to said event.
- I have read the Transportation Permission section of this form listed above, and.... REQUIRED Yes, I give permission for transportation as stated above. No, I do not give permission for transportation as stated above. Please fill out this field.
- Cell Phone Communication Permission
- I give permission for Good Shepherd Youth Ministry to contact my child via cell phone using Flocknote. REQUIRED Yes, I give permission for my child(ren) to be contacted on their cell phone using Flocknote. No, I do not give permission for my child(ren) to be contacted on their cell phone using Flocknote. Please fill out this field.
- If you answered "YES" to your child receiving messages on their cell phone via Flocknote, please provide the cell number. Please enter valid data.
- Please list allergies (e.g. food, drugs, anesthetics). If this does not apply, please write "NA." REQUIRED Please fill out this field.
- Please list medications taken regularly. If this does not apply, please write "NA." REQUIRED Please fill out this field.
- Please list any conditions/impairments (e.g. epilepsy, diabetes, asthma). If this does not apply, please write "NA." REQUIRED Please fill out this field.
Name of Middle Schooler 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.
- Grade Level (as of fall of 2025) REQUIRED Please fill out this field. Please enter an integer (number).
- School District REQUIRED Please fill out this field. Please enter valid data.
- Sex
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Transportation Permission
  
  I give permission for my child(ren) to be transported to and from regularly scheduled youth ministry activities by SafeParish-certified adults. I understand that by RSVPing for my child(ren) for a regularly scheduled offsite event, all permissions granted by this form apply to said event.
- I have read the Transportation Permission section of this form listed above, and.... REQUIRED Yes, I give permission for transportation as stated above. No, I do not give permission for transportation as stated above. Please fill out this field.
- Cell Phone Communication Permission
- I give permission for Good Shepherd Youth Ministry to contact my child via cell phone using Flocknote. REQUIRED Yes, I give permission for my child(ren) to be contacted on their cell phone using Flocknote. No, I do not give permission for my child(ren) to be contacted on their cell phone using Flocknote. Please fill out this field.
- If you answered "YES" to your child receiving messages on their cell phone via Flocknote, please provide the cell number. Please enter valid data.
- Please list allergies (e.g. food, drugs, anesthetics). If this does not apply, please write "NA." REQUIRED Please fill out this field.
- Please list medications taken regularly. If this does not apply, please write "NA." REQUIRED Please fill out this field.
- Please list any conditions/impairments (e.g. epilepsy, diabetes, asthma). If this does not apply, please write "NA." REQUIRED Please fill out this field.
Name of Middle Schooler 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.
- Grade Level (as of fall of 2025) REQUIRED Please fill out this field. Please enter an integer (number).
- School District REQUIRED Please fill out this field. Please enter valid data.
- Sex
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Transportation Permission
  
  I give permission for my child(ren) to be transported to and from regularly scheduled youth ministry activities by SafeParish-certified adults. I understand that by RSVPing for my child(ren) for a regularly scheduled offsite event, all permissions granted by this form apply to said event.
- I have read the Transportation Permission section of this form listed above, and.... REQUIRED Yes, I give permission for transportation as stated above. No, I do not give permission for transportation as stated above. Please fill out this field.
- Cell Phone Communication Permission
- I give permission for Good Shepherd Youth Ministry to contact my child via cell phone using Flocknote. REQUIRED Yes, I give permission for my child(ren) to be contacted on their cell phone using Flocknote. No, I do not give permission for my child(ren) to be contacted on their cell phone using Flocknote. Please fill out this field.
- If you answered "YES" to your child receiving messages on their cell phone via Flocknote, please provide the cell number. Please enter valid data.
- Please list allergies (e.g. food, drugs, anesthetics). If this does not apply, please write "NA." REQUIRED Please fill out this field.
- Please list medications taken regularly. If this does not apply, please write "NA." REQUIRED Please fill out this field.
- Please list any conditions/impairments (e.g. epilepsy, diabetes, asthma). If this does not apply, please write "NA." REQUIRED Please fill out this field.

FAMILY DOCTOR

What is the name of your family doctor? REQUIRED Please fill out this field. Please enter valid data.

Phone number for your family doctor. REQUIRED Please fill out this field. Please enter valid data.

#1 EMERGENCY CONTACT

List Emergency Contact (other than parents).

First Name Please enter valid data.

Last Name Please enter valid data.

Relationship Please enter valid data.

Phone Number Please enter a phone number.

#2 EMERGENCY CONTACT

List Emergency Contact (other than parents).

First Name Please enter valid data.

Last Name Please enter valid data.

Relationship Please enter valid data.

Phone Number Please enter a phone number.

ARCHDIOCESE OF CINCINNATI YOUTH PERMISSION FORM FOR MIDDLE SCHOOL YOUTH MINISTRY FOR REGULARY SCHEDULED ACTIVITIES IN THE TIMEFRAME LISTED FOR EACH EVENT/PROGRAM FOR JUNE 1, 2025 TO MAY 31, 2026.

Please download, read and retain the Archdiocese of Cincinnati Permission, Release and Authorization to Seek Medical Treatment form ►

I have read and agree to the Archdiocese of Cincinnati Permission, Release and Authorization to Seek Medical Treatment form that has been provided in the block above. REQUIRED Yes No Please fill out this field.

PHOTO PERMISSION
I understand that Good Shepherd’s Faith Formation staff may take photos and videos during activities for the purpose of promoting the programs via our website, Sunday bulletin, parish social media page (for example, Facebook, Twitter, Instagram), or news releases to local or diocesan papers. I give my permission for pictures that are taken of my family, adults and children, to be used for this purpose.

I have read and agree to the Photo Permission statement listed above. REQUIRED Yes No Please fill out this field.

Please be aware that we will continue to follow the guidelines of the Archdiocese of Cincinnati regarding social distancing and other precautions due to the COVID-19 pandemic. We appreciate your patience and flexibility in the event changes in the pandemic leads to restructuring of program dates and classroom capacities.

I have read and understand that we are following all Archdiocesan Guidelines related to the pandemic, and if changes occur with the pandemic we will adjust accordingly. REQUIRED Yes, I have read and agree to the statement above regarding the pandemic. Please fill out this field.

By clicking on the "I Agree" box, it will serve as your digital signature for this submission.

I Agree Please select this field.

If you would like to share any additional information, please do so in the box below.

Name of Custodial Parent/Legal Guardian REQUIRED Please fill out this field. Please enter valid data.

Please type your initials below. REQUIRED Please fill out this field. Please enter valid data.

Today's Date REQUIRED Please fill out this field. Please enter a date.

Middle School Youth Ministry Permission Form

Staff Contact

Middle School Youth Ministry Permission Form
June 1, 2025 to May 31, 2026