Middle School Ministry Registration Form
Fall 2026
Student Information
Name
*
First Name
Last Name
Grade
*
6
7
8
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
Male
Female
Parent / Guardian Information
Name
*
First Name
Last Name
Relation to Student
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Emergency Contact
If different from above
Name
First Name
Last Name
Relationship
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Medical / Special Needs
if any
Please list any allergies, medical conditions, medications, or special needs we should be aware of
Media Permission
check one
*
I give permission for my child to be photographed/video recorded for parish or ministry use (website, bulletin, social media)
I do NOT give permission (if permission is not granted, please explain to student that they may not pose for group photos)
Optional Section
I (parent) am interested in volunteering to assist with food prep and serving at beginning of a meeting
Date interested in volunteering
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: