LifeTeen Registration

Registration consists of two steps:
  1. Complete the form
  2. Send the completed form to the office via email
LifeTeen logo
Step 1

Family Information

Child/ren live with
Father's First Name
Father's Last Name
Father's Cell
Mother's First Name
Mother's Last Name
Maiden Name
Mother's Cell
Mailing Address
City
Zip Code
Family Home Phone
Father's Email
Mother's Email
Preferred language for mailings:

Teen 1 Information

First Name
Middle Initial
Last Name
Nickname (if applicable)
Birthdate
Birthplace
Teen's Email
2017-2018 School Name
Grade
Check completed sacraments:
If you are new to our program, please complete the Sacrament information for each received:
Date Parish Parish Address
Baptism
First Communion
Confirmation

Teen 2 Information

First Name
Middle Initial
Last Name
Nickname (if applicable)
Birthdate
Birthplace
Teen's Email
2017-2018 School Name
Grade
Check completed sacraments:
If you are new to our program, please complete the Sacrament information for each received:
Date Parish Parish Address
Baptism
First Communion
Confirmation

Diocese of Orlando Photography and Image Assignment, Waiver, and Release:

As parent or legal guardian, for valuable consideration received,, and for so being allowed access to Diocesan property, activities, or events, I do herby expressly assign to St. Mary Magdalen and the Diocese of Orlando, and to all of their current, former, and future agents and related entities (collectively, "the Diocese"), all rights, title and interest in, and to, the use of my and my child/ward’s image or likeness, including, but not limited to all videotape recordings, photographs, or audio recordings of, or made by, me and/or my child/ward on Diocesan property, during a Diocesan-sponsored event, or for any other Diocesan purpose ("the Property"). The Diocese shall have, without my consent, the right to assign its rights in the Property, in whole or in part, to any entity, parish, or school within the Diocese of Orlando.

I hereby irrevocably grant the Diocese perpetually and exclusively, the right to use and incorporate (alone or together with other materials), in whole or in part, the Property, in any Diocesan publication, news release, or for any other purpose. Further, I hereby authorize the reproduction, sale, lease, copyright, exhibition, broadcast and/or distribution of the Property without limitation for any purpose whatsoever, and I further waive all rights to any compensation for my and/or my child/ward’s appearance or participation in the Property. I understand and have been advised that photographs or videotape of participants may be used in publications, websites or other materials produced from time to time by the Office of Youth and Young Adult Ministry and/or the Diocese. Participants’ names would not be identified, however, without specific written consent. I further understand that the Diocese has no control over the use of photographs or film taken by media that may be covering the event in which my child(ren)/ward(s) participate(s).

I hereby waive any claims against and release the Diocese, its current, former, and future religious, employees, volunteers, agents, and successors and assigns from and against any and all claims, demands, actions, causes of actions, suits, costs, expenses, liabilities, and damages whatsoever that I and/or my child/ward may have against the Diocese in connection with the Property or the use of the Property.

This release shall not obligate the Diocese to use the Property or to use any of the rights granted hereunder, or to exhibit, distribute, or exploit the Property. I acknowledge that the Diocese cannot control all photographic access to its properties, and that my child/ward’s name may be printed with photos/images in various publications, including non-Diocesan publications.

I represent that I am eighteen years of age or older, and that I have read and understand the terms of this Agreement, Waiver, and Release.

Permission:
(Teen 1, Name)
Permission:
(Teen 2, Name)
Parent/Guardian Signature
Date

Consent & Liability Waiver:

I as parent or guardian of my son(s)/daughter(s), do hereby agree to allow my son(s)/daughter(s) to participate in the St. Mary Magdalen LifeTeen Program. I acknowledge that my child must comply with the SMM LifeTeen rules and procedures. By granting this permission, I also waive any claims against, and RELEASE AND HOLD HARMLESS AND INDEMNIFY, St. Mary Magdalen, the Diocese of Orlando, and any of their religious, employees, volunteers, agents and representatives from any liability, claims, demands and causes of action arising out of or relating to any loss, damage or injury sustained in connection with or arising out of my child’s participation in the program.

Furthermore, I understand that the St. Mary Magdalen Youth Ministry Program provides supervision of teens during scheduled hours of activities/programs only.

Parent/Guardian signature
Date
Step 2
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