Student Name
*
First Name
Last Name
E-mail
*
example@example.com
This email belongs to:
our family
the student
Emergency contact name
*
Must be 18 years old
Emergency contact phone
*
Please enter a valid phone number.
Student's current grade:
*
9th grade
10th grade
11th grade
12th grade
Going into 9th
This student's High School:
*
I plan to attend the following meeting dates:
*
June 4th, End of Year Bonfire *SPECIAL GIFT FOR 8th GRADERS AND HIGHSCHOOL SENIORS
My teen would like to attend the Well Coffeehouse at the Brecksville Starbucks on Mondays from 11pm-12pm (they will also receive a free Bible and highlighters) on the following dates:
June 5th
June 19th
June 26th
July 17th
July 24th
I learned about Assumption Youth Ministries from:
*
Facebook/Instagram
Attending Mass
Church Bulletin
School/PSR
Email
Other
Submit
Should be Empty: