2026-2027 &lt;br&gt;PATHS Confirmation&lt;br&gt; Registration

CHILD PARTICIPANT LEGAL NAME:

Child's First Name REQUIRED Please fill out this field. Please enter valid data.

Child's Last Name REQUIRED Please fill out this field. Please enter valid data.

Child's Middle Name REQUIRED Please fill out this field. Please enter valid data.

Child's Date of Birth REQUIRED Please fill out this field. Please enter valid data.

Choose One REQUIRED Please fill out this field.

Mothers Maiden Name REQUIRED Please fill out this field. Please enter valid data.

Address Where Child Participant Resides REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Child Participant Phone Number (include dashes) REQUIRED Please fill out this field. Please enter valid data.

Child Participant Email REQUIRED Please fill out this field. Please enter valid data.

Child Participant 2026-2027 High School Name REQUIRED Please fill out this field. Please enter valid data.

Child Participant Grade in Fall REQUIRED Please fill out this field.

H.S. Graduation Year REQUIRED Please fill out this field.

Child Participant Home Parish|Church REQUIRED Please fill out this field. Please enter valid data.

Church/Parish where your child was baptized:

Name and address of the church your child was baptized at: If your child was not baptized, please let us know this. REQUIRED Please fill out this field. Please enter valid data.

NOTE: If your child was NOT baptized at Saint Anne, Barrington, please email a copy of his or her baptismal certificate to [email protected]

CHILD PARTICIPANT HEALTH INFORMATION:

Child Participant Current Medication(s), Allergies and/or Health Concerns: NA or None if not applicable REQUIRED Please fill out this field.

PRIMARY CONTACT INFORMATION:

Parent|Guardian 1 First Name REQUIRED Please fill out this field. Please enter valid data.

Parent|Guardian 1 Last Name REQUIRED Please fill out this field. Please enter valid data.

Parent|Guardian 1 Relationship to Child - Example: Mother, Father, etc. REQUIRED Please fill out this field. Please enter valid data.

Parent|Guardian 1 Cell Number (include dashes) REQUIRED Please fill out this field. Please enter valid data.

Parent|Guardian 1 Email Address REQUIRED Please fill out this field. Please enter an email address.

PARENT|GUARDIAN 2 INFORMATION:

Parent|Guardian 2 First Name REQUIRED Please fill out this field. Please enter valid data.

Parent|Guardian 2 Last Name REQUIRED Please fill out this field. Please enter valid data.

Parent|Guardian 2 Relationship to Child - Example: Mother, Father, etc. REQUIRED Please fill out this field. Please enter valid data.

Parent|Guardian 2 Cell Number (include dashes) REQUIRED Please fill out this field. Please enter valid data.

Parent|Guardian 2 Email Address REQUIRED Please fill out this field. Please enter valid data.

Medical and Emergency Information:

Participant recognizes that the Archdiocesan Parties are not responsible to have medical personnel available during the Program or any associated activities, but Participant hereby agrees that personnel of the Archdiocesan Parties may authorize or perform emergency medical treatment if they believe that it is necessary for Participant’s health, safety and well-being. In the event of an injury or illness which requires immediate examination or treatment in the opinion of Archdiocesan Parties, Participant hereby authorizes the Archdiocesan Parties to have Participant transported by car or ambulance to the nearest hospital at Participant’s sole risk, cost and expense and Participant agrees that necessary emergency treatment may be given by any hospital personnel on call.

If this occurs, Participant hereby agrees that the efforts of the Archdiocesan Parties to contact Participant’s family as soon as practical after the injury or illness occurs shall be satisfactory, whether before or after treatment. Participant hereby understands and agrees that the Archdiocesan Parties assume no financial responsibility for ambulance conveyance or medical expenses incurred by Participant during, or resulting from, the Program and that the Archdiocesan Parties do not carry medical expense insurance for the benefit of Participant.

In the event that the primary or secondary contact can't be reached we will contact your emergency contact listed below.

I Agree - I Have Read and Agree With The Medical and Emergency Information REQUIRED Yes - I Agree -I Have Read and Agree With The Medical and Emergency Information Please fill out this field.

IN THE EVENT THE PARENT|GUARDIAN CAN'T BE REACHED, WHO SHALL WE CONTACT?

Emergency Contact First Name REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Last Name REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Phone Number (included dashes) REQUIRED Please fill out this field. Please enter valid data.

Relationship to Child: - Example: Grandfather, Grandmother, Neighbor etc. REQUIRED Please fill out this field. Please enter valid data.

PERMISSIONS:

Health Concerns, Medications or Emergency Contacts:

It is up to the Parent/Guardian to contact the Saint Anne Youth and Young Adult Ministry of any changes to their son or daughters Health Concerns, Medication or Emergency Contact.

I Agree - I Have Read and Agree With The Health Concerns, Medications or Emergency Contacts REQUIRED Yes, I have read and agree with the Health Concerns, Medication and Emergency Contact Please fill out this field.

Code of Conduct: Rules of Behavior for Students:

Attend all scheduled activities
Will not smoke, vape or engage in the use of alcohol or drugs or have them in their possession
Will treat all staff, volunteers and fellow participants with respect at all times
Will treat the facilities and grounds with respect at all times
Will abide by any and all additional Rules expressed by the staff and volunteers

Consequences of Not Abiding by the Rules:

For behavioral infractions or breaking of rules, warning will be given and the participant will have the opportunity to change the problematic behavior. If the problematic behavior continues, the participant will be removed from the program for the remainder of the year
If the participant uses alcohol or drugs during the event, even if they are not the one to bring them, the participant will be removed from the program for the remainder of the year
I understand that I am fully responsible for any damages that may occur as a result of the actions of the subject of this agreement and that neither Saint Anne Catholic Church, Barrington, IL, nor any of its agents will be held liable
I have read and acknowledge the above Rules of Behavior and Consequences of Not Abiding by the Rules governing this program

I Agree - I Have Read And Agree With The Code of Conduct REQUIRED Parent|Guardian: Yes - I Agree -I Have Read And Agree With The Code of Conduct Child Participant: Yes - I Agree- I Have Read And Will Follow The Code of Conduct Please fill out this field.

Email and Text Permission:

I give permission for my child participant to receive email and text communications from Saint Anne Catholic Church, Barrington, IL Youth and Young Adult staff and catechists.

I Agree - I Have Read And Agree With The Permissions To Receive Email And Text Communication REQUIRED Yes, I Have Read And Agree With The Permissions To Receive Email And Text Communication Please fill out this field.

Permission to use image, likeness and voice recording:

By registering for this program, participant hereby agrees and authorizes the Archdiocesan of Chicago and Saint Anne Catholic Church to use and reuse Participant’s image, likeness and voice recording in any photograph, video recording and/or audio recording (collectively “Recordings”) for the purposes of education, marketing or promotion of the Archdiocesan Parties without compensation or notice to Participant and the Recordings may be used within the websites, social media sites, brochures, magazines, books or other communication materials of the Archdiocesan of Chicago and Saint Anne Catholic Church at any time.

I Agree - I Have Read And Agree With The Permission to use image, likeness and voice recording REQUIRED Yes, I Have Read And Agree With The Permission to use image, likeness and voice recording Please fill out this field.

Release and Indemnify:

Participant hereby agrees to forever release and discharge the Parish, The Catholic Bishop of Chicago, an Illinois corporation sole and all of their affiliates, clergy, employees, agents, volunteers, successors and assigns (“Archdiocesan Parties”) from and against any and all claims, damages or liabilities resulting from or related to the Event and/or any personal injury, loss of life or damage of property sustained by Participant at or in any way related to the Program or this Agreement.

Participant hereby agrees to indemnify, defend and hold the Archdiocesan Parties harmless from and against any and all lawsuits, judgments, claims, actions, damages, losses and expenses (including reasonable attorneys’ fees) of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from Participant’s participation in the Program, including but not limited to such liability, claims and damages related to injury, illness, death, property damage and/or the Recordings which may occur during or in which any way relate to the Program or this Agreement.

Participant hereby waives any defense to the enforcement of any provision of this Agreement arising from a lack of consideration and Participant agrees that all of the terms of this Agreement are legal, valid and binding.

I Agree - I Have Read And Agree With The Release and Indemnify REQUIRED Yes, I Have Read And Agree With The Release and Indemnify Please fill out this field.

Volunteer Opportunities:

Yes, I am interested in volunteering as a small group catechist. Please tell us your first and last name followed by best contact information. Please enter valid data.

Maybe, I need more information on volunteering as a small group catechist. Please tell us your first and last name followed by best contact information. Please enter valid data.

By signing below, I agree I have read in full this registration and am in agreement with its terms.

Digital Signatures:

Parent|Guardian: Digital Signature (Please type first and last name) REQUIRED Please fill out this field. Please enter valid data.

Date REQUIRED Please fill out this field. Please enter a date.

Child Participant: Digital Signature (Please type first and last name) REQUIRED Please fill out this field. Please enter valid data.

Date REQUIRED Please fill out this field. Please enter a date.

PATHS Confirmation Registration Fee REQUIRED

3.0% for Credit Cards; 1.0% for ACH charges

240.0 – Year 1 - New To Program 375.0 – Year 2 - Returning to Program Please fill out this field.

Would you like to help offset online payment processing fees? REQUIRED

3.00% for Credit Cards; 1.0% for ACH charges

Yes, I can help - Credit Card only Yes, I can help - ACH only No, I do not wish to offset the online processing fee Please fill out this field.

2026-2027
PATHS Confirmation
Registration

Registration Form:

2026-2027 PATHS Confirmation Registration

2026-2027
PATHS Confirmation
Registration