St. Cassian Youth Ministry Registration Form
The St. Cassian Youth Group facilitates spiritual and social growth while providing education of the faith and offering opportunities to serve fellow children of God.  The Youth Group is open to youths from Grades 7 through 12.

To receive updates about our Youth Ministry, please complete the following form.

Thank you!
Lee Ann Rivera

www.stcassianchurch.org/youth-group-schedule/
LRivera@stcassianchurch.org
(973) 744 - 2850

TEEN INFORMATION:
Select one:
First Name:
Your answer
Last Name:
Your answer
Birth date:
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/
DD
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YYYY
School:
Your answer
Grade (as of Sept.):
Street Address:
Your answer
City:
Your answer
State:
Your answer
Zip Code:
Your answer
Cell Number:
Your answer
Would you like to receive updates via text?
Home Phone:
Your answer
Teen E-mail:
Your answer
PARENT/GUARDIAN INFORMATION
Parent/Guardian #1 Full Name:
Your answer
Parent/Guardian #1 Relationship to teen:
Your answer
Parent/Guardian #1 Cell Phone:
Your answer
Parent/Guardian #1 Home Phone:
Your answer
Parent/Guardian #1 Email:
Your answer
Parent/Guardian #2 Full Name:
Your answer
Parent/Guardian #2 Relationship to teen:
Your answer
Parent/Guardian #2 Cell Phone:
Your answer
Parent/Guardian #2 Home Phone:
Your answer
Parent/Guardian #2 Email:
Your answer
PARENTAL/GUARDIAN CONSENT
This portion should be completed by a parent/guardian.
As a parent/guardian, I understand that promotional pictures (individual and group) will be taken during youth group meetings and youth group events. I give my permission for my child's picture to be used for church promotional materials only (website, social media, local news media) as determined by the youth ministry office. I also give consent for the youth ministry office to contact my child directly via phone, text, or email. (Please sign/type your name below with your consent).
Your answer
Additional Comments:
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