High School LifeTeen Registration

Participant Name*

First NameLast Name

Participant Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Participant Home Phone Number

Participant Cell Phone*

Participant Email*

Participant Birth Date*

MonthDayYear

Gender:*

School Grade

9, 10, 11, or 12

T-Shirt Size (adult)*

School Attending

i.e. Lake Forest High School

Parent or Guardian (person filling out this form)*

MotherFatherGuardian

Parent Name:*

First NameLast Name

Parent Phone Number:*

Parent Email Address:*

I (Parent/s or Guardian) would like to minister at Life Nights by...

Please check the appropriate box ONLY if the statement applies:

My child has NOT been baptized or confirmed in the Catholic ChurchI would like to discuss baptism and/or sacrament prep for my child

Emergency Contact Name:*

First NameLast Name

Emergency Contact Phone Number:*

Emergency Contact Email:*

example@example.com

Emergency Contact Relationship:*

i.e. "Family Friend" or "Aunt"

Participant's Physician Name:

First NameLast Name

Participant's Physician Phone Number:

List Known Allergies:

List Dietary Restrictions:

List Current Medications:

Emotional/Psychological conditions/concerns:

Emergency Care Release*

I hereby grant permission for my child to be transported via ambulance and/or treated for emergency medical or dental problems if an emergency arises. I accept full responsibility for all medical expenses incurred as a result of my child's participation in this program.

Communications*

I hereby grant permission for the Youth Minister, Bridget Bicek, to directly contact my child via cell phone/email for the purpose of promoting Life Teen and/or youth ministry programs at St. Patrick Church, as well as healthy reminders of Christ's love for them

Media Release*

I hereby grant permission for my child to be photographed and/or video taped during Life Teen activities. I understand that my child may decline to be photographed and/or video taped at any time. I further grant permission for the resulting photographs and/or videotaped footage to be edited, if necessary, and then published and/or broadcast for the purpose of promoting the Life Teen and/or youth programs at St. Patrick Church.

Parent / Guardian Signature*

Parent / Guardian Name*

First NameLast Name

Date*

Date

St. Patrick’s Youth Ministry aims to promote an open, safe, and friendly environment where teenagers can feel comfortable and supported on their faith journey. We desire for every teenager to discover more about the beauty of the Catholic faith while having fun and connecting with other teenagers in the parish. The behavioral expectations listed below will assist in creating a community where high school students can grow in understanding themselves, others, and God. We will not hesitate to ask anyone to leave if their behavior is detrimental to others’ experience. If such happens, their parents will have to come pick them up.

Participation

Teenagers present are expected to willingly participate in every event and activity sponsored by Youth Ministry. We hope that every teenager will share the gifts that God has given him or her with the rest of the group! Cell phones must be put away during the entire youth ministry event, unless otherwise advised. The Youth Minister and other adult volunteers reserve the right to collect cell phones at any point.

Behavior

This is a House of God, and so we trust you to act with kindness and Christian charity. There should be no cursing, gossiping, exclusiveness, unkind words, or poor attitudes. Please, be respectful of others and remember that we are all brothers and sisters in Christ. Because each of us is a Temple of the Holy Spirit, teenagers should always be dressed appropriately.

Teenagers will be asked to leave any youth ministry event immediately if they….

Bring alcohol, drugs, pornographic materials, or any weaponry.
Bully others.
Display an intentional level of disrespect or apathy.
Steal or vandalize Church property.
Demonstrate inappropriate touching of any kind (massages, prolonged hugs, kissing etc.)

By signing below I understand and accept all of the behavioral expectations and requirements.

Participant Behavioral Expectations Acknowledgement*

I understand and accept all of the behavioral expectations and requirements as outlined above

Participant Signature (Behavioral Expectations)*

Participant Name*

First NameLast Name

Date*

Date

Please Note: Your registration form is not complete until you click the "Submit" button and see a Thank You page. A copy of your completed registration form will be emailed to you.

High School LifeTeen Registration

Participant Information

Parent Information

Medical Release

Communications and Media Release Statements

Parent / Guardian Signature

Behavioral Expectations