High School Youth Group Registration

Please complete one registration per high school student
Fee: Free or in-kind donation
CONTACT INFORMATION WILL BE ADDED TO OUR FLOCK NOTE COMMUNICATION SYSTEM

Student First Name REQUIRED Please fill out this field. Please enter valid data.

Student Last Name REQUIRED Please fill out this field. Please enter valid data.

Student Cell Phone REQUIRED Please fill out this field. Please enter valid data.

Student E-Mail REQUIRED Please fill out this field. Please enter valid data.

Student Birthday Please enter valid data.

High School REQUIRED Please fill out this field. Please enter valid data.

2018-19 Grade REQUIRED Please fill out this field. Please enter valid data.

Roman Catholic Sacraments Received

Check all that Apply

Baptism Reconciliation Eucharist Confirmation

Father's First Name Please enter valid data.

Father's Last Name Please enter valid data.

Address Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Cell Phone REQUIRED Please fill out this field. Please enter valid data.

Email REQUIRED Please fill out this field. Please enter an email address.

Mother's First Name Please enter valid data.

Mother's Last Name Please enter valid data.

Address Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Cell Phone REQUIRED Please fill out this field. Please enter valid data.

Email REQUIRED Please fill out this field. Please enter an email address.

Volunteer Opportunities

Click all that you are interested in

Life Teen Core Team Fall Retreat Team Social Event Team Arts & Environment (Life Teen & Retreat) Life Teen Liturgical Team Life Teen Music Team Kitchen Help (Life Teen/Retreat) SVC/Outreach Team Technology Help

I, (as parent/guardian) grant permission for my child, to participate in all Life Teen events/activities, sponsored by the Saint Simon the Apostle Youth Ministry Office. I/We hereby release and save harmless Saint Simon the Apostle and any and all of its employees from any and all liability for any and all harm arising to my/our son/daughter as a result of any event/activity/trip.

I Agree Please select this field.

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Please list any allergies or special medical problems that your child may have: Please enter valid data.

Please list any over the counter medications that you give permission to be administered by an adult to your child: Please enter valid data.

INSURANCE COMPANY REQUIRED Please fill out this field. Please enter valid data.

POLICY NUMBER REQUIRED Please fill out this field. Please enter valid data.

We believe that both the youth and the Parish benefit from positive recognition. There may be occasions for media coverage including your child(ren) throughout the year. We ask permission to release this type of communication. This could include, but not limited to:

Public Media: Newspaper, TV, Catholic Moment, any other public media. Church Media: Bulletin Boards, Parish Videos, Quarterly Newsletter, any other church media.

Web Based Media: Parish Web Site, Other related ministry and religious web sites.

I Agree Please select this field.

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Saint Simon the Apostle

A Community of Prayer, Praise and Worship

High School Youth Group Registration

Life Teen High School Youth Registration Form