About

Please join us for the annual Basilica of Saint Mary’s Knights of Columbus Free Throw Competition. Children ages 9 through 14 are encouraged to compete in this event and potentially move on to the Knights of Columbus District and State events. This is open to all Basilica School of Saint Mary’s students, Basilica of Saint Mary’s CCD students, and Basilica of Saint Mary’s CYO participants. 

Location: Basilica School of Saint Mary’s Gym

Date: Friday, February 14th, 2025

Time: 6PM-6:45PM (Ages 9-11)| 7PM-7:45PM (Ages 12-14)

Cost: Free of charge, bring a positive attitude and have fun!

All participants are required to fill out the Free Throw Entry Form and Permission Slip below!

Permission Form

"*" indicates required fields

Permission Form

Participant Name*

First Last

Date of Birth*

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Parish*

School*

Grade in 2024-25*

Parent/Guardian Name*

First Last

Address*

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Parent/Guardian Primary Phone*

Parent/Guardian Secondary Phone

Parent/Guardian Email*

Parental Permission and Liability Release*

As parent/legal guardian of the participant named above, I give my permission to participate fully in The Basilica of Saint Mary's Knights of Columbus Fitzgerald Council Free Throw Competition on Friday, February 14th at 6PM at the Basilica School of Saint Mary's Gym, 400 Green Street, Alexandria, VA 22314. I agree to indemnify and hereby release the Most Reverend Michael F. Burbidge of the Catholic Diocese of Arlington and his successors in office, as well as the Catholic Diocese of Arlington and all Diocesan clergy, employees, volunteers, and participating parishes and schools from any and all liability, claims, demands for personal injury, sickness and death, as well as property damage and expenses of any nature whatsoever which may be incurred by the undersigned of the participant resulting from said participant’s involvement in the above mentioned event (including transportation to and from the event). Furthermore, I on behalf of the participant hereby assume all risk of personal injury, sickness, death, damage, and expenses resulting from said participant’s involvement in the above-described event.

Informed Consent to Medical Treatment:*

I request that in my absence the above-named minor be admitted to any hospital or medical facility for diagnosis and treatment when a condition or injury arises that is serious enough that a reasonable person would seek care right away. I request and authorize physicians, dentists, and staff, duly licensed as Doctors of Medicine or Doctors of Dentistry or other such licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of the above minor. I have not been given a guarantee as to the results of examination or treatment. I authorize the hospital or medical facility to dispose of any specimen or tissue taken from the above-named minor. I assume full responsibility for all costs of such treatment. Further, should it be necessary for the participant to return home due to medical, disciplinary, or other reasons, I do hereby assume responsibility for the participant’s transportation home and any costs related thereto.

Photo, Press, Audio, and Electronic Media Release:

I authorize the Catholic Diocese of Arlington, its parishes, its schools and/or the Arlington Catholic Herald to use and publish my child’s photograph, video and/or audio recording along with their name identifying them for educational, news stories, illustration and/or marketing purposes.

Health Information

Primary Health Provider*

Phone Number*

Insurance Company*

Policy Number*

Emergency Contact Name*

First Last

Relationship*

Phone Number*

Known allergies (including any allergies to medicine)*

Any other medical problems which should be noted*

Consent*

I understand and hereby agree to the terms and conditions of the participant’s involvement in the above described event and I freely execute this Acknowledgement with full knowledge of its content.

Signature of Parent/Guardian*

Date*

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YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

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Questions?

Contact the Knights of Columbus at basilicaofstmarysknights@gmail.com or the Director of the Youth Apostolate, Mariane Staron, at mstaron@stmaryoldtown.org.