Vigil For Life (St. Jude group) registration
*Parents must register their children using this form for them to attend.*

Join us for the Vigil For Life happening downtown at St. John’s on Tuesday, January 21st from 7-9pm. It will be a night of praying for the respect of all life, especially the vulnerable unborn, Eucharistic Adoration, worship music led by Sarah Kroger, and hearing testimonies of hope and healing.

We will meet at St. Jude at 6pm at the Youth Center to ride to the event together. Parents are welcome to join as well, and we will need some help with driving (see below)!

The event is free, and donations will be accepted at the door. More general event details here:

Please contact Jacob Derry with any questions: or 269-580-0029
Teen First & Last Name(s) (you can list multiple children here if needed) *
Your answer
Teen Email Address(es) *
Your answer
Teen Phone Number(s) *
Your answer
Parent Name *
Your answer
Parent Email Address: *
Your answer
Parent Phone Number *
Your answer
You are representing St. Jude Parish and the Archdiocese of Indianapolis; therefore, appropriate dress and conduct that reflects Catholic Christian values is expected at this program. Thank you for your cooperation!

- Youth are expected to be with the St. Jude Group at all times.
- Youth are expected to wear appropriate attire.
- The possession or consumption of any alcohol or tobacco is NOT allowed.
- The possession of illegal drugs or weapons will result in having local police contacted.
- No foul or inappropriate language.
- No “PDA” (Public Displays of Affection) is allowed, including but not limited to kissing, holding hands, sitting on laps, or inappropriate touching.
- Throwing of objects and loud or disruptive behavior will not be tolerated.
- No carrying people on shoulders.
- No back talking or disrespectful language.
- If you are asked to leave the event, you may not return.
- Your parents will be notified if you fail to abide by the rules.
- Youth are expected to respect their peers, the speakers, the adult leaders who are there to assist them.
- Participants are expected check-in when arriving and check-out when leaving, including leaving the event earlier than the scheduled time.
I, the teen, understand and agree to the above Code of Conduct (Please type full name and today's date...again, you can have multiple teens sign here if needed). *
Your answer
I, the parent/guardian, agree that my child(ren) will abide by the above Code of Conduct (Please type full name and today's date) *
Your answer
I, the parent/guardian of the child(ren) listed above, grant permission for my child(ren) to attend the Vigil For Life to be held at St. John the Evangelist on January 21, 2020, and permission for my child(ren) to ride with an adult chaperone to the event. I will not hold St. Jude Parish, chaperones or representatives associated with St. Jude, or The Archdiocese of Indianapolis responsible in the event of injury. I agree to accept any and all financial responsibility as a result of scheduling necessary emergency medical treatment. I hereby warrant to the best of my knowledge, my child(ren) is/are in good health and I assume all responsibility for the health of my child(ren). In the event of an emergency, I hereby give permission to transport my child(ren) to a hospital for emergency medical treatment. I wish to be advised prior to any further treatment by the hospital or doctor.
I, the parent/guardian, agree to the above statement (please type your full name and today's date). *
Your answer
I, the parent, would like to attend the Vigil For Life too. *
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