One Acts Theatre Ministry | Youth Registration

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This field is for validation purposes and should be left unchanged.

How many teens are you registering for One Act Theatre Ministy at Nativity?

* Attending 8th-12th grade for the 2025-2026 school year.

Child 1: Information

Parent Information will be input after Child/ren's Information.

Child's Name(Required)

First Last Nickname

Sex(Required)

Male

Female

Date of Birth(Required)

T-Shirt Size(Required)

Cell Phone for Child 1(Required)

Do not enter a parent's phone number here. Click the box below if you do not want to list your child's cell or if they do not have one.

Check box if teen does NOT have a cell phone

Does not have cell phone

Email for Child 1(Required)

Enter Email Confirm Email

Do not enter a parent's email here. Click the box below if you do not want to list your child's email or if they do not have one.

Check box if teen does NOT have email

Does not have email

2025-2026 School Grade(Required)

8th

9th

10th

11th

12th

Name of School(Required)

Home Parish(Required)

Primary or Preferred Health Provider(Required)

Health Provider Phone(Required)

Health Insurance Company(Required)

Policy Number(Required)

Diocesan Requirement - for emergency purposes only.

Check box if child not currently insured

Child not currently insured

Please list any medical conditions or allergies that may affect your child's involvement in this program.

Comments

Please share anything you'd like us to know about your child and their participation in this program.

Child 2: Information

Parent Information will be input after Child/ren's Information.

Child's Name(Required)

First Last Nickname

Sex(Required)

Male

Female

Date of Birth(Required)

T-Shirt Size(Required)

Cell Phone for Child 2(Required)

Do not enter a parent's phone number here. Click the box below if you do not want to list your child's cell or if they do not have one.

Check box if teen does NOT have a cell phone

Does not have cell phone

Email for Child 2(Required)

Enter Email Confirm Email

Do not enter a parent's email here. Click the box below if you do not want to list your child's email or if they do not have one.

Check box if teen does NOT have email

Does not have email

2025-2026 School Grade(Required)

8th

9th

10th

11th

12th

Name of School(Required)

Home Parish(Required)

Is the health provider and insurance information for this child the same as Child 1?

Yes

Primary or Preferred Health Provider(Required)

Health Provider Phone(Required)

Health Insurance Company(Required)

Policy Number(Required)

Diocesan Requirement - for emergency purposes only.

Check box if child not currently insured

Child not currently insured

Please list any medical conditions or allergies that may affect your child's involvement in this program.

Comments

Please share anything you'd like us to know about your child and their participation in this program.

Child 3: Information

Parent Information will be input after Child/ren's Information.

Child's Name(Required)

First Last Nickname

Sex(Required)

Male

Female

Date of Birth(Required)

T-Shirt Size(Required)

Cell Phone for Child 3(Required)

Do not enter a parent's phone number here. Click the box below if you do not want to list your child's cell or if they do not have one.

Check box if teen does NOT have a cell phone

Does not have cell phone

Email for Child 3(Required)

Enter Email Confirm Email

Do not enter a parent's email here. Click the box below if you do not want to list your child's email or if they do not have one.

Check box if teen does NOT have email

Does not have email

2025-2026 School Grade(Required)

8th

9th

10th

11th

12th

Name of School(Required)

Home Parish(Required)

Is the health provider and insurance information for this child the same as Child 1?

Yes

Primary or Preferred Health Provider(Required)

Health Provider Phone(Required)

Health Insurance Company(Required)

Policy Number(Required)

Diocesan Requirement - for emergency purposes only.

Check box if child not currently insured

Child not currently insured

Please list any medical conditions or allergies that may affect your child's involvement in this program.

Comments

Please share anything you'd like us to know about your child and their participation in this program.

Parent / Guardian Information

Name of Parent or Legal Guardian(Required)

First Last

Cell Phone(Required)

Home Phone

Work Phone

Primary Email(Required)

Enter Email Confirm Email

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Relationship to Teen(Required)

Mother

Father

Other

Additional parent/guardian?(Required)

Yes

Parent / Guardian Information

Name of Parent or Legal Guardian(Required)

First Last

Cell Phone 2(Required)

Home Phone 2

Work Phone 2

Primary Email 2(Required)

Enter Email Confirm Email

Relationship to Teen?(Required)

Mother

Father

Other

Parental Permissions and Consents

Applies to all teens registered on this form.

Parental Permission and Liability Release(Required)

PARENTAL PERMISSION AND LIABILITY RELEASE | As parent/legal guardian of the participant names above, I give my permission to participate fully in Nativity One Act Theatre Ministry for the 2025-2026 school year. I agree to indemnify and hereby release the Most Reverend Michael F. Burbidge of the Catholic Diocese of Arlington and his successors in office, as well as the Catholic Diocese of Arlington and all Diocesan clergy, employees, volunteers, and participating parishes and schools from any and all liability, claims, demands for personal injury, sickness and death, as well as property damage and expenses of any nature whatsoever which may be incurred by the undersigned of the participant resulting from said participant’s involvement in the above mentioned event (including transportation to and from the event). Furthermore, I on behalf of the participant hereby assume all risk of personal injury, sickness, death, damage, and expenses resulting from said participant’s involvement in the above-described event.

I agree

Informed Consent to Medical Treatment(Required)

INFORMED CONSENT TO MEDICAL TREATMENT | I request that in my absence the above-named minor be admitted to any hospital or medical facility for diagnosis and treatment when a condition or injury arises that is serious enough that a reasonable person would seek care right away. I request and authorize physicians, dentists, and staff, duly licensed as Doctors of Medicine or Doctors of Dentistry or other such licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of the above minor. I have not been given a guarantee as to the results of examination or treatment. I authorize the hospital or medical facility to dispose of any specimen or tissue taken from the above-named minor. I assume full responsibility for all costs of such treatment. Further, should it be necessary for the participant to return home due to medical, disciplinary, or other reasons, I do hereby assume responsibility for the participant’s transportation home and any costs related thereto.

I agree

Photo, Press, Audio, and Electronic Media Release(Required)

PHOTO, PRESS, AUDIO, AND ELECTRONIC MEDIA RELEASE | I authorize the Catholic Diocese of Arlington, its parishes, its schools and/or the Arlington Catholic Herald to use and publish my child(ren)’s photograph, video and/or audio recording along with their name identifying them for educational, news stories, illustration and/or marketing purposes.

I agree

Signature of Parent or Legal Guardian(Required)

Your Name
Your Name
Your Name

Type Your Full Legal Name(Required)