St. Joseph Mission School Registration Form

Was this student enrolled at St Joseph Mission School during the previous year?
(If yes, please update address information and any other information that has changed...especially phone numbers...it is not necessary to complete entire form if information is current.)
Date of Birth:
Date of Birth:
Baptism:
Date:
Date:
1st Communion:
Date:
Date:
Confirmation:
Date:
Date:
Father's Info
Phone:
Phone:
Cell:
Cell:
Mother's Info
Phone:
Phone:
Cell:
Cell:
Guardian Info (if applicable)
Phone:
Phone:

Please bring copies of your child's Birth Certificate, Baptismal Certificate, Immunization Records, SS Card, CIB, and his/her last report card with evidence of promotion from the last school attended.

Request for Photography Consent and Release

Dear Parents/Guardians:


There may be individuals present taking photographs or otherwise videotaping events during school hours or at
school-sponsored events from time to time. These individuals may be conducting these activities on behalf of the
school, the Roman Catholic Church of the Diocese of Gallup, NM ("Diocese''), or a parish within the Diocese, or may
be the friends or family of other students, faculty or staff. We cannot control the spontaneous photography or
videotaping by friends or family of other students, faculty or staff. However, we can and we do attempt to control the
photography and videotaping on behalf of the school, Diocese, and parishes, which may be performed by outside
photographers, news media or our own faculty or staff. The purpose of this communication is to request your consent
to our use of any photograph or video of your child that may be taken at school or during school-sponsored events.

 

If you consent below, you agree that the school, Diocese, or parish(es) may record your child's voice, image, and
likeness, alone or with others and with or without your child's creative works or projects, on any media (photography,
video, digital, or otherwise, with or without sound) and may use, publish, display, and reproduce those recordings,
either with or without modification or alterations (such as cropping or color enhancement) along with your child's
name and involvement in school activities or clubs for school-related media, creative works, brochures, websites, and
bulletin boards to be used for the purpose of publicity, recruitment, fundraising, evangelization and other
communication efforts on behalf of the school, the Diocese or parish(es). These recordings may be used in any media,
including without limitation on the Internet, and they may be displayed publicly and prominently, possibly for a long
time or permanently.


By consenting below, you agree to release and hold harmless the Diocese and related schools, parishes, trustees,
agents, officers, contractors, volunteers and employees from and against any and all claims, demands, actions,
complaints, suits or other forms of liability that may arise out of or by reason of, or be caused by the use of your
child's name, photograph or likeness, voice or creative work(s), on television, radio, motion picture, print media,
social media (such as Facebook and Instagram) or on the Internet or other electronic medium, including any claims
for payment, claims of defamation, and claims regarding rights of privacy or publicity. You may withdraw your
consent at any time by contacting the Diocese at .

You understand that by releasing the Diocese and related parties you are giving up rights you may otherwise retain on behalf of your
child and waive the benefit of any law that provides that a general release does not extend to claims that you do
not know or suspect exist at the time of executing this release.

 


If you elect to consent below, you understand and agree that no payment, money or other consideration in any form
will be due to you, your child, or your heirs, agents or assigns at any time because of your child's participation in any
of the above activities or the above-described use of your child's name, photograph, likeness, voice or creative
work(s).

 

Please indicate on the next page whether you are providing your consent to the recording of your child as set forth
above and return the form to the Diocese. If you have any questions or concerns you may contact your school or the
Diocese.

 

____I consent to the creation of recordings of my child by or on behalf of the school, the Roman Catholic Church
of the Diocese of Gallup, NM, and/or its parishes, as set forth in this Request for Photography Consent and Release.


____ I do not consent to the creation of recordings of my child as set forth by or on behalf of school, the Roman
Catholic Church of the Diocese of Ga1lup, NM, or its parishes as set forth in this Request for Photography Consent
and Release, and release the Roman Catholic Diocese of Gal1up, NM of any liability from spontaneous photographs
taken by third parties outside of the Diocese's control. I understand that by electing this option my child will still be
photographed for inclusion in the school yearbook and internal school files.


Signature of Parent or Guardian or Student if over 18 years of age

Date