Youth Group Registration

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Father's Name Please enter valid data.

Mother's Name Please enter valid data.

Teen Address above is the address of Both Parents Mother Father Legal Guardians

Teen Email Please enter an email address.

Father's Email Please enter an email address.

Mother's Email REQUIRED Please fill out this field. Please enter an email address.

Teen Cell Number REQUIRED Please fill out this field. Please enter a phone number.

Father's Cell Number Please enter a phone number.

Mother's Cell Number REQUIRED Please fill out this field. Please enter a phone number.

Teen's Allergies (if none, type "None") REQUIRED Please fill out this field.

Date of Birth (dd/mm/yyyy) REQUIRED Please fill out this field. Please enter valid data.

Sex

School Attending REQUIRED Please fill out this field. Please enter valid data.

Grade REQUIRED Please fill out this field.

Teen has received the following sacraments (check all that apply) Catholic/Christian Baptism Reconciliation Eucharist (Communion) Confirmation

Teen is currently enrolled in Confirmation Program at Sacred Heart of Mary

I give permission for photos of my teen partiipating in youth events to be posted on Sacred Heart of Mary's website, Sacred Heart of Mary's weekly bulletin, and/or social media for Sacred Heart of Mary.

I Agree Please select this field.

Email to receive registration confirmation REQUIRED Please fill out this field. Please enter an email address.

I give permission for the youth director and youth ministers to contact my teen via text and/or email, for upcoming Sacred Heart of Mary youth events and reminders.

I Agree Please select this field.

Would you be willing to prepare a whole meal or share meal prep with another person for our youth group on a Sunday during the year? Just gauging interest. We will contact you if you are interested. REQUIRED Please fill out this field.

Youth Group Donation (optional) $ Please enter a positive decimal.