Life Teen Registration 2018-2019
Please fill out the survey to the best of your ability.
Teen's First and Last Name
Your answer
Teens Grade *
Required
Teens email address
Your answer
Teens phone #
Your answer
School Attending
Your answer
Teens date of birth
MM
/
DD
/
YYYY
Which sacraments does your child have? *
Required
Did your child attend faith information last year?
Parent/Guardian Names
Your answer
Parent/Guardian Address (Street/PO Box, City, State, Zip)
Your answer
Parent/Guardian Phone #
Your answer
Please type in parent/guardian email address *
Your answer
Emergency Contact Person and Phone #
Your answer
Family Doctor's Name
Your answer
Family Doctor's Phone Number
Your answer
Teen's Allergies
Your answer
Medications your child takes regularly
Your answer
Do you give Life Teen core members permission to give over the counter medications to your child? (Tylenol, Imodium, etc.)
Is your child allowed to drive to and from Life Teen events?
T-shirt size
Would you like to help volunteer for any Life Teen events?
Submit
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