CYO Track & Field Registration - The Basilica of Saint Mary

How Many Participants Are You Registering?*

Parish*

Participant Information

Participant Name*

First Last

Date of Birth*

Sex*

Grade in 2025-26*

Religious Education Program*

per Diocesan standards, all children must be actively enrolled in a Religious Education program such as the Basilica School of Saint Mary, CCD, or equivalent.

Known allergies (including any allergies to medicine)*

Any other medical problems which should be noted*

Participant 2 Information

Participant Name*

First Last

Date of Birth*

Sex*

Grade in 2025-26*

Religious Education Program*

per Diocesan standards, all children must be actively enrolled in a Religious Education program such as the Basilica School of Saint Mary, CCD, or equivalent.

Known allergies (including any allergies to medicine)*

Any other medical problems which should be noted*

Participant 3 Information

Participant Name*

First Last

Date of Birth*

Sex*

Grade in 2025-26*

Religious Education Program*

per Diocesan standards, all children must be actively enrolled in a Religious Education program such as the Basilica School of Saint Mary, CCD, or equivalent.

Known allergies (including any allergies to medicine)*

Any other medical problems which should be noted*

Participant 4 Information

Participant Name*

First Last

Date of Birth*

Sex*

Grade in 2025-26*

Religious Education Program*

per Diocesan standards, all children must be actively enrolled in a Religious Education program such as the Basilica School of Saint Mary, CCD, or equivalent.

Known allergies (including any allergies to medicine)*

Any other medical problems which should be noted*

Participant 5 Information

Participant Name*

First Last

Date of Birth*

Sex*

Grade in 2025-26*

Religious Education Program*

per Diocesan standards, all children must be actively enrolled in a Religious Education program such as the Basilica School of Saint Mary, CCD, or equivalent.

Known allergies (including any allergies to medicine)*

Any other medical problems which should be noted*

Parent/Guardian Information

Parent/Guardian Name*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Parent/Guardian Primary Phone*

Parent/Guardian Secondary Phone

Parent/Guardian Email*

Family Physician Phone*

Insurance Carrier & Policy Number*

Permission Form

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

Parental Permission and Liability Release*

As parent/legal guardian of the participant named above, I give my permission to participate fully in the CYO Track & Field from March through May 2026. I agree to indemnify and hereby release the Most Reverend Michael F. Burbidge Bishop 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. 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.

Code of Conduct

As I consider my participation in NVJCYO, I am asked to reflect on the letters “C” and “Y” in the acronym—and how Catholic youth sports must be different. Each time a youth takes the field, court, track or other venue it can be an incredibly productive event. Whether it actually is productive depends on me… … me, as an athlete, challenging myself to use all the gifts given by the Lord, the coach, and those who care for me. … me, as a coach or spectator, remembering that the game or activity should be about long-term formation in every sense of the word—physical, mental, social and spiritual. What is at stake is nothing less than the mental and spiritual well-being of those who hear my words and see my actions. If I am to set an example at all, I pray it will be a good one.

What I Expect of Myself and Others Expect of Me (All Athletes, Coaches, Spectators must acknowledge and agree to terms in order to participate)*

Additionally for Spectators, Parents, Guardians…*

I will respect the coaches’ time and effort and will leave the coaching to them during the games, and focus on how I can make the most of my role in encouraging my player.

I understand that it is my responsibility as the parent or guardian to ensure that I do not leave my youth at an activity until there are 2 appropriate adults to chaperone him/her.

I will remain in the bleachers/on the sideline and never enter the field of play or court; I will also stay off the playing surface after the game and will not congregate in the foyers so that the next teams may warm-up and proper egress is maintained.

I will not allow those under my care to roam free, especially under the bleachers, in the hallways, foyers, restrooms, on the stages, on parish grounds or in parking lots.

Signature of Parent/Guardian*

Date*

Payment

The registration fee is $60 per youth participant.

Credit Card

Cardholder Name

Card Details

Participant 1*

Price:

Participant 2*

Price:

Participant 3*

Price:

Participant 4*

Price:

Participant 5*

Price:

Total