Middle School Registration Form 2022-2023

Middle School Youth Group

“Be who God meant you to be and you will set the world on fire.” Saint Catherine of Sienna
Student's Name *

First Name Middle Name Last Name
Birth Date *

Month Day Year
Gender *
What grade is your student? *
Registration Options *

My child will attend the Middle School formation on Tuesdays: 6:45 pm - 8 pm I am going to homeschool my Middle School student. Please provide me with the necessary resources.
My child's t-shirt size is: *
Has this child been Baptized? *

Yes No
Do you want more information about having your child baptized?

Yes No
Has this child received 1st Holy Communion?

Yes No
Do you want your child to prepare for 1st Holy Communion?

Yes No
Allergies or things we should know about your child?
Student registered by. Please fill out if you are not the child's parent.

First Name Last Name
Parent Information *

First Name Last Name
Parent Cell Phone Number
Parent Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Emergency Contact *

First Name Last Name
Emergency Contact Mobile Number *
I, the parent/guardian listed above, grant permission for my child (the participant listed above) to participate in the events listed above. I understand that these events will take place under the guidance and direction of parish employees and/or volunteers from the parish. As parent/legal guardian of the participant listed above, I remain legally responsible for any personal action taken by my child. I agree to hold harmless the Church of Ascension and the Diocese of Richmond as well as its officers, directors, agents, chaperones, or representatives associated with this event, arising from or in connection with my child attending this event, or including but not limited to accidents, emergencies, exposures to reckless conduct of persons. I also understand that if any medical changes occur during this timeframe, I am responsible for updating my medical release form with the parish. *

I Understand
PHOTO RELEASE: Occasionally, photos of events may appear on the church website and/or in printed materials such as the parish newsletter. No identifying information will accompany the images. I grant permission to Church of the Ascension to photograph my child and use his/her picture, silhouette, or other reproductions of physical likeness in connection with publications (i.e. newsletters, website, brochures), video recordings or news releases of Church of the Ascension. *

Yes No
Should be Empty:

Now create your own Jotform - It's free! Create your own Jotform

Middle School Youth Group