Mission Youth Registration Form

Register for a Coatesville Mission!

Please purchase a shirt if you do not have one! There is an option later on in the form...Come on mission with us as we encounter souls in Coatesville. Mass, crosswalks, prayer, adoration, confessions, highs and lows and FELLOWSHIP! Saint Peter Catholic Church: 2835 Manor Road West Brandywine, PA 19320. Crosswalks and door to door evangelization in Coatesville
Name of Participant*

First NameLast Name
E-mail*
Birth Date*

MonthDayYear
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
We hope there will be no emergencies, but just in case, what is the name of a Parent/Guardian/Emergency Contact? This question is required.*

First NameLast Name
Parent/Guardian/Emergency Contact Cell Phone Number: This question is required.*

Area CodePhone Number
Parent/Guardian/Emergency Contact EMAIL: This question is required. This will be used to communicate important details about mission locations before the mission.*
example@example.com
Please list any allergies and/or medical conditions of the participant here:
Do you agree to the terms? By agreeing you certify that as a parent/guardian (if the above registrant is under 18) or adult registrant (if over 18) have read and agree to all the terms included in the here referenced Saint Peter Catholic Church waivers and that by selecting below to agree to these terms is binding in a court of law. (If under 18 CLICK HERE). (if over 18 CLICK HERE). I have read and understand the above permission form in its entirety, and also understand that it is a legal document and I agree and consent to all terms and conditions contained within.This question is required.

*ELECTRONIC SIGNATURE (Please Type Your First and Last Name).
Name*

First NameLast Name
Signature*

Clear
Do you have a Mission Youth T-shirt or hoodie? Please click here to purchase Mission Youth gear online! (Please take into consideration the time it takes to ship to you).

The Missionary Uniform: Mission Youth t-shirt or hoodie, jeans, and closed-toed shoes. No flip flops, thin-sole shoes, leggings, shorts. Please respect our dress code.
Mission Youth Registration (Not required, free will offering)

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USDMission Youth Donation
Note: You may use your PayPal account to pay if you have one. If you do not have a PayPal account, you may select "Pay with Debit or Credit Card" when prompted.
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Register for a Coatesville Mission!