Youth & Family Ministry Group Sign Up
Event Timing: Ongoing
Event Address: 141 Henry Street, NY, NY 10002
Contact us at (212) 233-0233 or StTeresaYouthNY@gmail.com
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Last Name *
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Email *
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Date of Birth *
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Which Youth & Family Ministry Group are you signing up for? *
Is your family registered at St. Teresa Church? *
Dietary restrictions *
Any Special needs or relevant information that you would like us to know: *
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Emergency Contact ( Last Name, First Name) *
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Emergency Contact Phone Number *
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Who is allowed to pick up Student: (Please provide full name and contact phone numbers) *
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Who is allowed to pick up Student: (Please provide full name and contact phone numbers) *
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Electronic Signature (Last Name, First Name) *
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I understand that checking this box constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of the information provided in this document. *
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