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Middle School Youth Group 2017-2018 Registration
This form is for 6th, 7th, and 8th grade students who want to participate in Middle School Youth Group activities. All sacramental programs for IHM (Children's Faith Formation, Sacramental Preparation, High School Youth Group and Confirmation) have different registration forms. Please ensure you are on the right form, and that you click SUBMIT at the bottom when you have completed filling in all of the fields. This form must be filled out by a Parent/Guardian to be valid.
Youth First Name
Your answer
Youth Last Name
Your answer
Youth Cell Phone Number
Your answer
Can IHM Youth Ministry send your youth texts?
Youth Date of Birth
Your answer
What grade are you in?
What's your t-shirt size?
What school do you attend?
Your answer
Sacraments Received
Required
Home Phone Number
Your answer
Mailing Address
Number and Street
Your answer
City
Your answer
Zip Code
Your answer
Parent/Guardian 1 Full Name
First/Last
Your answer
Parent/Guardian 1 Relationship to Youth
Your answer
Parent Cell Phone Number
Your answer
Parent E-Mail
Your answer
Parent/Guardian 1 Marital Status
Parent/Guardian 1 Religion
Your answer
Parent/Guardian 2 Full Name
First/Last
Your answer
Parent E-Mail
Your answer
Parent Cell Phone Number
Your answer
Parent/Guardian 2 Relationship to Youth
Your answer
Parent/Guardian 2 Marital Status
Parent/Guardian 2 Religion
Your answer
Emergency Contact Name
If parent/guardian cannot be reached at any above numbers
Your answer
Emergency Contact Phone Number
Cell or home
Your answer
Emergency Contact Alternate Phone Number
Cell or home
Your answer
Emergency Contact Relationship to Youth
Your answer
Are you registered in our parish?
List any special needs
ADD, learning difficulties, physical difficulties, medications, allergies
Your answer
List any dietary restrictions
Vegetarian, vegan, food allergies
Your answer
Consent to Photograph or Film for IHM Advertisements/Promotional Use
I consent to participation in interviews, use of quotes, and the taking of photographs or film of myself and the minor children in my guardianship or care. I grant Immaculate Heart of Mary Parish (IHM) the right to use the materials, without any compensation to me, for IHM advertising, editorial, or informational purposes. I release IHM and its agents and employees from all claims, demands, or liabilities in connection with the above.
Required
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