TEEN (NOT PARENT) Cell Phone (for online assignments) *
Teen lives with: (check all that apply) *
Please ensure that all information is correct before submitting. Should ANY information change while your teen is in our program, please let us know!
Both Parents/Guardian's Names *
The Parent/Guardian serving as Primary Contact *
Primary Contact Cell Phone *
Please enter 10-digit number
Primary Contact Email *
Mailing STREET Address *
City & ZIP CODE *
Does the candidate have reliable internet access via phone or home service? *
Please check all that apply: *
IMPORTANT: I understand that IF SPACES ARE AVAILABLE, I will need to submit a copy of my teens BAPTISMAL CERTIFICATE upon final registration or they will not be input into a class. (Even if Baptized at OLPH) *
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