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Faith in Action Registration Page

- When
  
  July 18-25, 2025
- Where
  
  Missouri State University (Springfield), Tulsa (Oklahoma), and Oklahoma City
- Click Here for More Details
Summer 2025 Registration
- This form is not accepting responses at this time.
  
  PARTICIPANT INFORMATION
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate REQUIRED Please fill out this field. Please enter a date.
  
  Grade Level REQUIRED Please fill out this field.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Mobile Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Address 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.
  
  PARENT INFORMATION
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mobile Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  EMERGENCY CONTACT (not a parent)
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mobile Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  LIABILITY RELEASE
  
  As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above-named minor (“participant”). I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend the Diocese of Lafayette-in-Indiana, its officers, directors, employees and agents, chaperones, or representatives associated with the event, from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the Diocese of Lafayette-in-Indiana, its officers, directors, its employees and agents, chaperones, or representatives associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the Diocese of Lafayette-in-Indiana.
  
  Please answer according to the liability statement above: REQUIRED Yes No Please fill out this field.
  
  MEDICAL RELEASE
  
  We give our permission for our son/daughter, in case of emergency, to be taken to a physician or hospital by either a parent in charge or by parish personnel. We understand that every effort will be made to contact us. If we cannot be reached, we hereby give permission to the physician selected by the parish member in charge or adult chaperone(s) to secure proper treatment for our son/daughter.
  
  Please answer according to the liability statement above: REQUIRED Yes No Please fill out this field.
  
  MEDIA RELEASE
  
  On occasion, St. Alphonsus Liguori Catholic Church takes photographs or makes an audio or video recording of children and/or adults involved in parish activities. Images may be used on parish print, electronic, and social media platforms.
  
  I expressly grant to St. Alphonsus Liguori Catholic Church the right, privilege and license to use the picture or likeness of my child/children in any photograph, movie, video production or any other forms of media publication and to use the verbal or written statements or declarations of my child/children for the purpose of publicizing, fostering and promoting the parish and its programs.
  
  Please answer according to the publicity statement above: REQUIRED Yes No Please fill out this field.
  
  Deposit100.0
  
  I understand that my $100 deposit is non-refundable. Please select this field.
  
  I understand that I must participate in fundraising efforts to receive credit for the fundraiser. Please select this field.
  
  If my student cannot attend the mission pilgrimage and a replacement cannot be found, I understand that I am responsible for the remaining payment after fundraising. Please select this field.
  
  Total:
  
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