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3sixty High School Youth Ministry Registration 2012-2013

The program year is from September to August.

Program Fee:

  • Early Registration before September 9th is $65 for one youth and $120 for two youths
  • Registration after September 9th is $75 for one youth and $140 for two youths

*Note: program fees cover administrative and operational expenses for the program. Fees do not include extra 3sixty activities or events. If you have financial concerns, please contact the Youth Coordinator. No youth will be turned away due to lack of funds.

Please submit completed form with payment. Online payment information will be on the next page. 

check all that apply
Emergency Information
Please list two emergency contacts, in case a parent cannot be reached.
Medical and Release Information
In case of an accident or serious illness, I request 3sixty Youth Ministry to contact me. If they are unable to reach me, I hereby authorize them to call my youth's primary physician, indicated below, and follow his/her instructions. If the physician cannot be reached, they may make the necessary arrangements to seek medical care.
Photo Release Statement
Please check one option
I hereby grant permission for my youth to be photographed and/or video recorded during 3sixty activities and events. I understand that my youth may decline to be photographed and/or video recorded at any time. I further grant permission for the resulting photographs and/or video footage to be edited, if necessary, and then published and/or broadcasted for the purpose of promoting 3sixty and/or youth programs at Holy Spirit Parish.
I hereby decline permission for my youth to be photographed and/or video recorded during 3sixty activities and events. I have instructed my youth to decline to be photographed and/or video recorded at all times. I have further instructed my youth to notify 3sixty leaders that he/she may not be photographed and/or video recorded under any circumstances.
Support Team: parents who are able to support 3sixty as an event chaperon, driver, and setup/cleanup crew.
Sponsorship or Donation
Please make donation checks payable to Holy Spirit Church, with "3sxity Donation" on the memo line. Mail donations to: Holy Spirit Church, 3sixty Youth Ministry, 1200 Redmond Avenue, San Jose, CA 95120.
Parental Agreement
In typing my name and date below, I acknowledge that the information I have given is accurate. I agree to direct my youth to cooperate with the rules and instructions of the ministry and parish. In the event that my child consistently misbehaves and/or acts inappropriately, I agree to be contacted by the youth leader and pick up my youth from the event. If the problem continues to persist, I understand that my child may be removed from the program for the remainder of the year.