High School & Middle Youth Ministry

High School & Middle Youth Ministry

Registration Form 2022-23
This form is for High School and Middle Youth participants. The information on this form assists our team in understanding the unique needs and life situation of your teen. This information is treated as strictly confidential and will only be shared with our team on a need-to-know basis. Required information is in bold.
Teen First and Last Name*
Preferred Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
Date
Grade in Fall 2022
School
Family Phone
Father's Name
Father's Phone
Mother's Name
Mother's Phone
Has Your Teen Received the Sacraments of Initiation? (Baptism, Eucharist, Confirmation) Check all that apply

BaptismReconciliation and CommunionConfirmation
Youth lives with
Parents’ marital status
Does your teen have any physical and/or learning disabilities?
Please list any other helpful information here allergies/medications etc
Registration fee is $20 for first child, $15 for second child, $10 for third child. No fee beyond the third child.
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