High School Youth Registration 2018-2019
Please complete this form to register for youth ministry in the 2018-2019 academic year. Please send the medical release to Deacon Grimm at ppalm@bedeva..org.
Last Name *
Your answer
First Name *
Your answer
Preferred Name *
Your answer
Middle Name *
Your answer
Grade (2018-2019 School Year) *
Confirmation
Please note that the Confirmation fee is IN ADDITION to the youth ministry fee to cover the cost of the retreat and online Confirmation program
Confirmation (cont.)
Answer only for those seeking to be confirmed
Are you a registered parishioner at St. Bede? *
School Attending 2018-2019 *
Date of Birth *
MM/DD/YYYY
Your answer
Gender *
T-Shirt Size *
Youth Email Address
Your answer
Youth Cell Phone Number
Your answer
Mailing Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Name of Parent/Guardian *
Your answer
Parent/Guardian Email Address *
Your answer
Parent/Guardian Cell Phone Number *
Your answer
Name of 2nd Parent/Guardian
Your answer
2nd Parent/Guardian Email Address
Your answer
2nd Parent/Guardian Cell Phone Number
Your answer
In case a parent cannot be reached in an emergency, please notify:
Your answer
Emergency Contact Phone Number
Your answer
Please note if there are special family circumstances that would be helpful for us to know about:
Your answer
Does the youth participant have any physical, emotional, or sensory conditions? *
If yes, please list below:
Your answer
Does the youth participant have any dietary restrictions? *
If yes, please list below:
Your answer
Medical Release *
Please complete the medical release and submit it to Deacon Grimm at ppalm@bedeva.org. Registration will not be complete until the it has been submitted to Deacon Grimm. MEDICAL RELEASE FORM: https://www.bedeva.org/media/1/22/Permission-Release%20Form%202018-2019.pdf
Required
Cost *
Required
Small Group Suggestion
Please indicate one person with whom the youth participant would like to be in a small group with. Please note that we make no guarantees for small group suggestions.
Your answer
Subscribe to Email Updates *
Required
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