Name and phone number of an adult to reach in case of emergency in the event that you cannot be reached at the numbers above.

To help us prepare for NCYC, please check all that apply involving allergies, health and behavioral concerns.

I understand and consent that photographs and video recordings/audio recordings of my child may be taken, produced and may be used in publications, websites or other materials produced from time to time by the Office of Youth and Young Adult Ministry, the Diocese of Jefferson City and parishes of the Diocese of Jefferson City (collectively "Diocese"). I also understand that my child will not be identified, without written consent. In consideration of the parish allowing my child to participate in the event/activity, I grant the Diocese the right to publish, reproduce and display photogenic images/video recordings/audio recordings of my child for use in all media, electronic or otherwise, in connection with publications, web pages and/or social media of the Diocese. I hereby authorize the reproduction, sale, lease, copyright, exhibition, broadcast and/or any distribution of said photographs/video recordings/audio recordings without limitation for any purpose whatsoever; and I further waive all rights to any compensation for my child's appearance or participation in the photographs/video recordings/audio recordings. I hereby expressly assign to the Diocese, all the rights, title and interest in, and to all the photographs/video recordings/audio recordings made by such in which my child appears and/or his/her voice is used in and in connection with the video recording of this event. I understand and acknowledge that the Diocese has no control over the use of photographs/video recordings/audio recordings taken by media that may be covering the event in which my child participates.

I, as parent or guardian of my child, do hereby agree to allow my child to participate in NCYC, 2025, November 20-23, 2025, traveling by charter bus. I acknowledge receipt of the information provided describing the planned activity. I acknowledge that the Diocese of Jefferson City is providing transportation to and from the event/activity. I acknowledge and assume the risk of this transportation for my child. My child must comply with the parishes rules and procedures. In consideration of the parish allowing my child to participate in the event/activity, I also waive any claims against, and RELEASE AND HOLD HARMLESS AND INDEMNIFY, the Diocese of Jefferson City, the parish and any of its and/or their religious, employees, volunteers, agents and representatives from any liability, claims, demands and causes of action and claims 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 event/activity, including transporting my child to and from the event/activity.

In signing the line below I agree to abide by any/all policies established for this event/activity. Should I not be able to maintain the guidelines and expectations of the adults and my peers, I understand that there will be consequences for my actions, including being removed from the activity and being sent home at my parent/guardians expense. Please check the following boxes to indicate your agreement.