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
This student's High School:
*
I plan to attend the following meeting dates:
*
Sunday, October 2nd at 7pm - PUMPKIN CARVING CONTEST
Sunday, October 16th at 7pm
Sunday, November 13th at 7pm
I learned about Assumption Youth Ministries from:
*
Facebook/Instagram
Attending Mass
Church Bulletin
School/PSR
Email
Other
Submit
Should be Empty: