LifeTeen & Edge Registration Form
Registration form for LIfeTeen & Edge 2019-2020
* Required
Student Name
*
Your answer
Student Email Address
*
Your answer
Mother's Name
*
Your answer
Mother's Email Address
*
Your answer
Mother's Phone Number
*
Your answer
Father's Name
*
Your answer
Father's Email Address
*
Your answer
Father's Phone Number
*
Your answer
Student Lives With
*
Mother
Father
Both Parents
Grandparents
Other:
Emergency Contact Name
*
Your answer
Emergency Contact Phone Number
*
Your answer
Home Address
*
Your answer
Home Phone Number
*
Your answer
Sex
*
Male
Female
Birth Date
*
MM
/
DD
/
YYYY
School
*
Your answer
Grade
*
6th
7th
8th
9th
10th
11th
12th
Allergies
*
Your answer
Special Needs
*
Your answer
Sacraments NEEDED
*
Baptism
1st Reconciliation
1st Communion
Confirmation
Required
Sacraments RECEIVED
*
Baptism
1st Reconciliation
1st Communion
Confirmation
Required
Is the student's Baptism certificate on file with the church?
*
Yes
No
Student's T-shirt Size
*
Small
Medium
Large
XLarge
2XLarge
Registration Payment Options
*
$50 payment (cash or check)
Pay $2 per week at LifeTeen & Edge
Submit
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