Youth Ministry Registration
Registration for the 2023-2024 year for 5th - 12th Grade Students
Family Name:
*
Last Name
Primary Email:
*
example@example.com
Secondary Email:
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent Information:
Mother's Name:
*
First Name
Last Name
Mother's Phone Numeber:
*
Please enter a valid phone number.
Mother's Email:
*
example@example.com
Is the mother Catholic?
*
Yes
No
Father's Name:
*
First Name
Last Name
Father's Phone Number:
*
Please enter a valid phone number.
Father's Email:
*
example@example.com
Is the father Catholic?
*
Yes
No
Child (ren) live with:
*
Mother
Father
Other
Emergency Contact
In the event of an emergency, or if unable to reach the parents/guardians, please contact (must be a non-parent):
Emergency Contact:
*
First Name
Last Name
Cell Phone:
*
Please enter a valid phone number.
Relationship:
*
Relationship to Student
Student's Information
Student 1:
*
First Name
Last Name
Student 1 Information:
Student 1 Needs the following Sacraments:
*
Baptism
First Communion
Confiramtion
None
Student 2:
First Name
Last Name
Student 2 Information:
Student 2 Needs the following Sacraments:
Baptism
First Communion
Confiramtion
None
Student 3:
First Name
Last Name
Student 3 Information:
Student 3 Needs the following Sacraments:
Baptism
First Communion
Confiramtion
None
Student 4:
First Name
Last Name
Student 4 Information:
Student 4 Needs the following Sacraments:
Baptism
First Communion
Confiramtion
None
Student 5:
First Name
Last Name
Student 5 Information:
Student 5 Needs the following Sacraments:
Baptism
First Communion
Confiramtion
None
Student 6:
First Name
Last Name
Student 6 Information:
Student 6 Needs the following Sacraments:
Baptism
First Communion
Confiramtion
None
Consent:
Medical Consent:
Name
*
First Name
Last Name
Type a question
*
Date
*
-
Month
-
Day
Year
Date
Photo Consent:
Name
*
First Name
Last Name
Type a question
*
Date
*
-
Month
-
Day
Year
Date
Consent to Contact:
Please add student name, email and cell phone number here:
Example: John Paul jesusfreak@gmail.com 616-920-9155
Name
First Name
Last Name
Type a question
Date
-
Month
-
Day
Year
Date
Payment:
$40.00 for one child, $75.00 for two or more Maximum is $75.00 per family If possible, payment is expected at the time of registration. If financial help is needed, please contact Tony Allen at 616-935-8737.
*
I will pay online
I will drop off payment to the office/dropbox
Other
Submit
Submit
Should be Empty: