Parish You Are Registered With
* Parent Name
* Parent Phone
* Home Address
Middle School Participant(s) Name / Age / Grade (in the Fall) / T-Shirt Size / Medications or Allergies
Emergency Contact Name
* Emergency Contact Name
Emergency Contact Relationship
Emergency Contact Number
* Emergency Contact Number
Name of Family Physician
* Physician Number
Name of Insurance Company
o Medical Authorization: I understand that the Catholic Arch/Diocese of Phoenix 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.
o Permission for Other Medical Matters: YES, 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.
o Release of Liability for Youth and Adults: I understand all reasonable safety precautions will be taken at all times by the Catholic Arch/Diocese of Phoenix 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 Arch/Diocese of Phoenix and Totus Tuus, its leaders, employees and volunteer staff from any and all claims arising from or in connection with attending this event.
o Code of Behavior for Youth and Adults: 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 Arch/Diocese of Phoenix or its chaperones/representatives.
o Photo release: YES, I hereby authorize the Catholic Arch/Diocese of Phoenix and Totus Tuus and its agents to utilize photographic and/or video images of me or my child by the Catholic Arch/Diocese of Phoenix. In giving my consent, I hereby indemnify and hold harmless the Catholic Arch/Diocese of Phoenix 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.
"I represent and certify that I, as parent/guardian of the child(ren) named above, have read the entirety of this agreement and fully understand the contents, consequences, and implications of signing this agreement and that I agree to be bound by this agreement.
Thank you! You have officially submitted your intention to attend Totus Tuus at St. Thomas Aquinas. We have limited availability, so it is first come, first served. If you register after all of the spots are taken, you will be placed on a wait list and kept informed if a spot opens up! Once you have registered, please submit payment to the office within one week:
$50 for one child (for the whole week), $20 for additional siblings up to 5 children in total (must be siblings all registrations turned in together), capped at $125 total for 6 siblings or more.