Totus Tuus Registration

Family Name REQUIRED Please fill out this field. Please enter valid data.

Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.

Address Please enter valid data.

Primary Email REQUIRED Please fill out this field. Please enter an email address.

Primary Number REQUIRED Please fill out this field. Please enter a phone number.

Cell Phone for reminder text messages Please enter a phone number.

Emergency Name (if you cannot be reached) REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Number REQUIRED Please fill out this field. Please enter a phone number.

Family Physician Name REQUIRED Please fill out this field. Please enter valid data.

Family Physician Number REQUIRED Please fill out this field. Please enter a phone number.

Insurance Company REQUIRED Please fill out this field. Please enter valid data.

Policy Number REQUIRED Please fill out this field. Please enter valid data.

Cost REQUIRED 20.0 – 1 Child 40.0 – 2 Children 50.0 – 3+ Children Please fill out this field.

Number of Students Registering REQUIRED Please fill out this field.
Student 1
- Students Name REQUIRED Please fill out this field. Please enter valid data.
- If different, name child goes by: Please enter valid data.
- Grade in Fall 2023 REQUIRED Please fill out this field.
- Medical Condition / Allergies Please enter valid data.
- Prescribed Medications Please enter valid data.
- Disability / Learning Support Services Please enter valid data.
Student 2
- Students Name REQUIRED Please fill out this field. Please enter valid data.
- If different, name child goes by: Please enter valid data.
- Grade in Fall 2023 REQUIRED Please fill out this field.
- Medical Condition / Allergies Please enter valid data.
- Prescribed Medications Please enter valid data.
- Disability / Learning Support Services Please enter valid data.
Student 3
- Students Name REQUIRED Please fill out this field. Please enter valid data.
- If different, name child goes by: Please enter valid data.
- Grade in Fall 2023 REQUIRED Please fill out this field.
- Medical Condition / Allergies Please enter valid data.
- Prescribed Medications Please enter valid data.
- Disability / Learning Support Services Please enter valid data.
Student 4
- Students Name REQUIRED Please fill out this field. Please enter valid data.
- If different, name child goes by: Please enter valid data.
- Grade in Fall 2023 REQUIRED Please fill out this field.
- Medical Condition / Allergies Please enter valid data.
- Prescribed Medications Please enter valid data.
- Disability / Learning Support Services Please enter valid data.
Student 5
- Students Name REQUIRED Please fill out this field. Please enter valid data.
- If different, name child goes by: Please enter valid data.
- Grade in Fall 2023 REQUIRED Please fill out this field.
- Medical Condition / Allergies Please enter valid data.
- Prescribed Medications Please enter valid data.
- Disability / Learning Support Services Please enter valid data.

PHOTO & VIDEO CONSENT

I hereby authorize the Catholic Diocese of Manchester and Totus Tuus and its agents to utilize photographic and/or video images of me or my child by the Catholic Diocese of Manchester. In giving my consent, I hereby indemnify and hold harmless the Catholic Diocese of Manchester and Totus Tuus and its agents from any and all responsibility of liability. I understand that I will receive no compensation should any photograph and/or video of mc or my child be used.

I consent (see photo/video use above) REQUIRED Yes No Please fill out this field.

I (name below), am custodial parent/legal guardian of the participant and request that s/he be allowed to participate in Totus Tuus to be held at St. John Neumann Parish July 2023.

Medical Authorization:

I understand that the Catholic Diocese of Manchester and Totu Tuus assume no responsibility for accidents which may Occur in association with diocesan events and activities. I agree to use my/our personal insurance to cover any such incidents. I understand that, in the event medical intervention is needed, every' attempt will be made to contact the persons listed above. In the event those individuals cannot be reached, I/We hereby give permission to the physician or any other qualified medical staff selected by the event leader to hospitalize, secure medical treatment, and/or order injection, anesthesia, or surgery for Participant as deemed necessary.

Release of Liability. for Youth and Adults:

I understand all reasonable safety precautions will be taken at all times by the Catholic Diocese of Manchester and Totus Tuus and its employees and agents during the events and activities. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree to indelnnify and hold harmless the Catholic Diocese of Manchester and Totus Tuus, its leaders, employees and volunteer staff from any and all claims arising from or in connection with attending this event.

Code of Behavior for Youth and Adults:

I agree to abide by and/or instinct my child to abide by all rules and regulations as outlined by the aforementioned chaperones/representatives. I agree that if I/participant fail(s) to abide in any way by the rules, that I/Participant can be dismissed from the event, and sent home immediately at my/Participant's expense with no right of reimbursement or refund for any amount in connection therewith from the Catholic Diocese of Manchester or its chaperones/representatives.

Submittal constitutes electronic signature of named parent/legal guardian below REQUIRED Please fill out this field. Please enter valid data.

I would like to volunteer as indicated below:

Contact Claire Bryson if you have additional questions

Host college students (women) Host college students (men) Dinner (Sat) Dinner (Sun) Dinner (Mon) Dinner (Tues) Dinner (Wed) Dinner (Thurs)

Please note, your registration submittal is not finalized until your payment has been received. Please click on the 'Proceed to Payment' button to submit registration then pay online. Once clicked you will receive email to primary email account acknowledging registration information received. The email will also have a link to payment page in case you were unable to complete payment portion. If you encounter problems, the payment does not look correct, or you need financial assistance, please email us, call or stop by the office.

Thank you!

St. John Neumann catholic parish

708 Milford Rd, Merrimack nh 03054

(603) 880-4689

Totus Tuus Registration

St. John Neumann Parish is hosting Totus Tuus this summer!

Rising grades 1-6: 9am - 3pm Monday-Friday, July 24-28
Rising grades 7-12: 6:30 - 8:30 pm Sunday-Thursday, July 23-27

Online Registration Form

Totus Tuus Registration

Rising grades 1-6: 9am - 3pm Monday-Friday, July 24-28 Rising grades 7-12: 6:30 - 8:30 pm Sunday-Thursday, July 23-27

Rising grades 1-6: 9am - 3pm Monday-Friday, July 24-28
Rising grades 7-12: 6:30 - 8:30 pm Sunday-Thursday, July 23-27