2020 HAD Registration

2020 Hands Across Duluth July 14-17 Registration and Permission Form

To register for HAD, please fill out the form below, hit "submit" and also pay the $90 registration fee; either online by clicking on the button below, or sending in a check made out to St. Paul's to the office. Registrations are only complete once the nonrefundable fee is paid. Registration is on a first come, first serve basis and we did have a waiting list last year with several names, so don't delay in registering.

HAD Registration
Complete all the required fields and hit submit

* Indicates required field

Youth Name *

First

Last

Grade in Fall 2020 *

Youth Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent Name *

First

Last

Parent Phone Number *

2nd Parent Name *

First

Last

2nd parent Phone Number *

Primary Contact Parent Email *

2nd Parent Email *

Any medical conditions, allergies (food or environmental) special needs or anything else we need to know while your child is in our care? *

Emergency Contact name AND phone number *

Insurance company, policy number and group number *

Primary physician and phone number *

Medical Release We (I) give my permission for my child _________________________ to attend a youth ministry event sponsored by St. Paul’s Church. We (I), authorize an adult, in whose care the above named minor has been entrusted by us or a staff member of St. Paul’s Church to consent to any reasonably necessary medical examination, anesthetic, medical, surgical, or dental diagnosis or treatment, and/or hospital care, to be rendered to the above named minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of Minnesota law and an active member of the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of any such physician or any such hospital, clinic, or urgent care facility. We (I), the undersigned shall be liable and agree to pay all costs and expenses incurred in connection with such medial and dental services rendered to the aforementioned child pursuant to this authorization. We (I) understand that should it be necessary for our (my) child to return to my care due to medical reasons or otherwise, that I shall assume all transportation costs. If you agree sign your name in the box below. *

WAIVER I, , Parent/Guardian, on behalf of (“Participant Minor Child”) do hereby release, waive, discharge, and covenant not to sue and agree to hold members of St. Paul’s Church its officers, directors, employees, representatives, agents and affiliates, and the staff of St. Paul’s Church from any and all claims, demands and actions of any and every kind directly or indirectly arising out of or relating in any respect to the participation of the Participant Minor Child. My waiver and release of all claims, demands, actions, and liability shall include without limitation, any injury, illness, death, property damage or loss to the Participant Minor Child which may be caused by any act, or failure to act by the staff of St. Paul’s Church or sustained before, during or after the event unless such injury, illness, death, property damage or loss is a direct result of the willful misconduct of either the church or the staff. I understand that, without limitation of the foregoing, the Church of St. Paul’s Church shall not be liable and is hereby released from all claims that may arise from loss or damage to the Participant Minor Child’s personal property for whatever reason. Neither the Church of St. Paul’s shall be responsible for any lost or stolen property of the Participant Minor Child or any persons attending activities thereof. I also give permission for my child’s picture but not name to be used on the parish website, bulletin board and newsletter. If you agree sign your name below. *

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Online payment for HAD

2020 Hands Across Duluth July 14-17 Registration and Permission Form

HAD Registration ​Complete all the required fields and hit submit

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HAD Registration
Complete all the required fields and hit submit