• This form is not accepting responses at this time.

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

    Last Name REQUIRED Please fill out this field. Please enter valid data.
  • Date of Birth REQUIRED Please fill out this field. Please enter a date.
  • Age Please enter valid data.
  • Home Address REQUIRED Please fill out this field. Please enter valid data.
  • City REQUIRED Please fill out this field. Please enter valid data.

    State REQUIRED AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Please fill out this field.

    Zip REQUIRED Please fill out this field. Please enter a zip code.
  • 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.
  • Gender REQUIRED (Select One) Male Female Please fill out this field.
  • Grade 2025-2026 REQUIRED Please fill out this field. Please enter valid data.
  • Tshirt Size REQUIRED (Select One) Small Medium Large X-Large XXL Please fill out this field.
  • I Agree Please select this field.
  • Parent/Guardian
  • First Name REQUIRED Please fill out this field. Please enter valid data.

    Last Name REQUIRED Please fill out this field. Please enter valid data.
  • 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.
  • I grant permission for my child to participate in 2025 Archdiocesan Youth Conference to be held July 25-27, 2025 at Hilton Americas - Downtown Houston. In consideration of my child’s participation in this event, I agree on behalf of myself, my child named herein, and our heirs, successors, and assigns to indemnify, hold harmless and defend the Archdiocese of Galveston-Houston, the sponsoring parish, its pastor, youth ministry leader, principal, other agents, employees or other representatives associated with the event from any and all injuries, losses or claims arising out of my child’s participation in the event. In signing this form I certify that all information contained herein is true and accurate to the best of my knowledge.
  • I Agree Please select this field.
  • VIDEO/PHOTOGRAPHY CONSENT As parent/guardian, I understand that promotional pictures and videos (individual and group) will be taken during this event.  I give permission for my son’s/daughter’s picture to be used for promotional materials (newsletter, web page, calendars, power point, video etc.) in highlighting the event. 
  • I Agree Please select this field.
  • Medical Matters I hereby warrant to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.  Of the following statements pertaining to medical matters, sign only those in accordance with your wishes:  
  • Emergency Medical Treatment In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment.  I wish to be advised prior to any further treatment by the hospital or doctor and I understand that all financial obligations are my responsibility.   In the event of an emergency and you are unable
  • I Agree Please select this field.
  • I hereby ____Permission for nonprescription medication (such as Tylenol, throat lozenges, cough syrup) to be given to my child, if deemed advisable. I understand that Aspirin will not be given to my son/daughter. REQUIRED REQUIRED Grant DO NOT GRANT Please fill out this field.
  • In the event it comes to the attention of the chaperones associated with the activity that my child becomes ill with repeated symptoms such as headache, vomiting, sore throat, fever, diarrhea, I want to be called immediately.  If this will be a long distance call, I want to be called collect (with phone charges reversed to myself). I fully understand the foregoing statements and sign this Parental/Guardian Medical Consent Waiver knowingly, freely, and willingly.  
  • I Agree Please select this field.
  • Medications My child will bring all such medications, well labeled, that are necessary. Names of medications and concise directions for seeing that the child takes such medications, including dosage and frequency are as follows
  • I understand that the fee to attend AYC 2025 is $250 by June 14. After this date, the fee goes up to $275.
  • I Agree Please select this field.

  Submit

  This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.