LifeTeen & Edge Registration Form
Registration form for LifeTeen & Edge 2020-2021
* 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
None
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
Parent / Guardian Agreement
Please sign at the bottom of this paragraph.
I understand that I, as the parent or legal guardian of the child listed above, am required to read the parent handbook provided by the Religious Education program at St John the Evangelist Catholic Church. I understand and agree to abide by the guidelines, rules, and regulations set forth in this handbook. I understand that my child(ren) need(s) to observe the basic rules of conduct and adhere to the rules stated in the handbook. I understand that failure to comply with the family handbook could bring about disciplinary actions including, in extreme cases, dismissal of my child from the catechetical program. I understand that I am responsible for sharing the rules, regulations and other important information in this handbook with my child.
*
Your answer
Medical Release
Please sign at the bottom of this paragraph.
I grant permission for the administration of first aid to my child by the people in charge of St. John the Evangelist, and to make the necessary referrals to qualified physicians for treatment of illness or accidents of a more serious nature. In the case of a medical emergency, I understand that every effort will be made to contact the parents/guardian of the participant. In the event, I cannot be reached I hereby give permission to the physician selected by the adult staff to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery, if deemed as necessary for my child.
*
Your answer
Media Release
I give permission for my child to be photographed / videoed during LifeTeen & Edge events for the purpose of publicizing the church's activities on social media and in print.
Please check any and all that apply to your student.
*
You have my permission to take my child's picture and / or video my child.
I wish to withhold permission to photograph and / or video my child.
Required
Parent or Guardian Signature:
*
Your answer
Registration Payment Options
*
$50 payment (cash or check)
Pay $2 per week at LifeTeen & Edge
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms