Saint Agnes High School Youth Group

SAINT AGNES PARISH

HIGH SCHOOL YOUTH GROUP
Welcome! This form is to register your child as a member of our High School Youth Group at Saint Agnes Parish in West Chester, PA. You and your child will be added to our email list to receive updates about upcoming events and activities.
Participant Information
Child's Name*

First NameLast Name
Grade*
School*
Parish*
Parent Information
Parent/Legal Guardian Name*

First NameLast Name
Phone Number*
Format: (000) 000-0000.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Medical Information
Please indicate whether your child has any allergies or medical conditions that we should be aware of.
In the event of an emergency, please indicate whether your child is taking any prescription medications that first responders should be aware of.
Other
Any comments, questions, suggestions?
Consent
YesNo
If so, please provide the child's email below:
example@example.com
YesNo
I, {parentlegalGuardian}, the parent or legal guardian of {childsName}, give my permission for the items checked "Yes" above, and for my child to participate in Saint Agnes High School Youth Group.
Parent's Signature

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Date Signed

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Date
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SAINT AGNES PARISH