Youth Ministry Registration

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PARENT/GUARDIAN INFORMATION
- Parents/Guardians REQUIRED Please fill out this field.
- Parent 1
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Relationship to Youth REQUIRED Please fill out this field. Please enter valid data.
  - Email REQUIRED Please fill out this field. Please enter an email address.
  - Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.
  - Home Phone Number Please enter a phone number.
- Parent 2
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Relationship to Youth REQUIRED Please fill out this field. Please enter valid data.
  - Email REQUIRED Please fill out this field. Please enter an email address.
  - Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.
  - Home Phone Number Please enter a phone number.
Family Info
- Family 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.
- Are you registered at St. Alphonsus Parish? REQUIRED Yes No Please fill out this field.
- If not, where are you registered? Please enter valid data.
Help with our Ministry
- Would you be willing to help in our ministry? REQUIRED Yes No Tell me more. Please fill out this field.
- If so, please choose one or more of the following:
- 4:twelve Retreat I'd love to help!
- 4:twelve Small Group Leader Sign me up!
- Antioch Retreat I'd love to help!
- Antioch Small Group Leader Sign me up!
- Antioch Kitchen Help Sure!
- Confirmation Mentor (not sponsor) I'd love to be a mentor!
- Office Help (mailings, flyers, etc.) Happy to do this!
- Per Event when Available (luncheons, trips, etc.) Sure - no problem!
Emergency Contact (other than parent)
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Relationship to Youth REQUIRED Please fill out this field. Please enter valid data.
- Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.
STUDENT INFORMATION
- Number of Children REQUIRED Please fill out this field.
- Child 1
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Date of Birth: mm/dd/year REQUIRED Please fill out this field. Please enter valid data.
  - Grade (Fall 2017) REQUIRED Please fill out this field.
  - Confirmed? REQUIRED Yes No Please fill out this field.
  - If YES, please list the name and city of your church of baptism. Please enter valid data.
  - I plan to receive the Sacrament of Confirmation at the end of the year. Yes No
  - Student Email Please enter an email address.
  - Student Cell Phone Please enter a phone number.
  - Registered in Youth Ministry last year? REQUIRED Yes No Please fill out this field.
  - List any talents, hobbies, activities... Please enter valid data.
  - Please list any allergies. Please enter valid data.
  - List up to 3 peers to be in your child's small group.
  - Peer 1 Please enter valid data.
  - Peer 2 Please enter valid data.
  - Peer 3 Please enter valid data.
- Child 2
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Date of Birth: mm/dd/year REQUIRED Please fill out this field. Please enter valid data.
  - Grade (Fall 2017) REQUIRED Please fill out this field.
  - Confirmed? REQUIRED Yes No Please fill out this field.
  - If YES, please list the name and city of your church of baptism. Please enter valid data.
  - I plan to receive the Sacrament of Confirmation at the end of the year. Yes No
  - Student Email Please enter an email address.
  - Student Cell Phone Please enter a phone number.
  - Registered in Youth Ministry last year? REQUIRED Yes No Please fill out this field.
  - List any talents, hobbies, activities... Please enter valid data.
  - Please list any allergies. Please enter valid data.
  - List up to 3 peers to be in your child's small group.
  - Peer 1 Please enter valid data.
  - Peer 2 Please enter valid data.
  - Peer 3 Please enter valid data.
- Child 3
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Date of Birth: mm/dd/year REQUIRED Please fill out this field. Please enter valid data.
  - Grade (Fall 2017) REQUIRED Please fill out this field.
  - Confirmed? REQUIRED Yes No Please fill out this field.
  - If YES, please list the name and city of your church of baptism. Please enter valid data.
  - I plan to receive the Sacrament of Confirmation at the end of the year. Yes No
  - Student Email Please enter an email address.
  - Student Cell Phone Please enter a phone number.
  - Registered in Youth Ministry last year? REQUIRED Yes No Please fill out this field.
  - List any talents, hobbies, activities... Please enter valid data.
  - Please list any allergies. Please enter valid data.
  - List up to 3 peers to be in your child's small group.
  - Peer 1 Please enter valid data.
  - Peer 2 Please enter valid data.
  - Peer 3 Please enter valid data.
- Child 4
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Date of Birth: mm/dd/year REQUIRED Please fill out this field. Please enter valid data.
  - Grade (Fall 2017) REQUIRED Please fill out this field.
  - Confirmed? REQUIRED Yes No Please fill out this field.
  - If YES, please list the name and city of your church of baptism. Please enter valid data.
  - I plan to receive the Sacrament of Confirmation at the end of the year. Yes No
  - Student Email Please enter an email address.
  - Student Cell Phone Please enter a phone number.
  - Registered in Youth Ministry last year? REQUIRED Yes No Please fill out this field.
  - List any talents, hobbies, activities... Please enter valid data.
  - Please list any allergies. Please enter valid data.
  - List up to 3 peers to be in your child's small group.
  - Peer 1 Please enter valid data.
  - Peer 2 Please enter valid data.
  - Peer 3 Please enter valid data.
- Child 5
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Date of Birth: mm/dd/year REQUIRED Please fill out this field. Please enter valid data.
  - Grade (Fall 2017) REQUIRED Please fill out this field.
  - Confirmed? REQUIRED Yes No Please fill out this field.
  - If YES, please list the name and city of your church of baptism. Please enter valid data.
  - I plan to receive the Sacrament of Confirmation at the end of the year. Yes No
  - Student Email Please enter an email address.
  - Student Cell Phone Please enter a phone number.
  - Registered in Youth Ministry last year? REQUIRED Yes No Please fill out this field.
  - List any talents, hobbies, activities... Please enter valid data.
  - Please list any allergies. Please enter valid data.
  - List up to 3 peers to be in your child's small group.
  - Peer 1 Please enter valid data.
  - Peer 2 Please enter valid data.
  - Peer 3 Please enter valid data.
- Child 6
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Date of Birth: mm/dd/year REQUIRED Please fill out this field. Please enter valid data.
  - Grade (Fall 2017) REQUIRED Please fill out this field.
  - Confirmed? REQUIRED Yes No Please fill out this field.
  - If YES, please list the name and city of your church of baptism. Please enter valid data.
  - I plan to receive the Sacrament of Confirmation at the end of the year. Yes No
  - Student Email Please enter an email address.
  - Student Cell Phone Please enter a phone number.
  - Registered in Youth Ministry last year? REQUIRED Yes No Please fill out this field.
  - List any talents, hobbies, activities... Please enter valid data.
  - Please list any allergies. Please enter valid data.
  - List up to 3 peers to be in your child's small group.
  - Peer 1 Please enter valid data.
  - Peer 2 Please enter valid data.
  - Peer 3 Please enter valid data.
Parish Media and Communications
- MEDIA RELEASE
  
  Help us share about our parish community. In order to promote ministry and share images of community, St. Alphonsus Liguori takes photos and video to for things like brochures and bulletins that get handed out, or on the parish website and social media accounts. Please let us know if you have preferences for using images or video of ministry outside the parish that may have your youth's face visible.
- Please select one of the following: REQUIRED Open usage: Permission for use of photos and video with child's image for parish website, printed publications, and social media. Limited usage: Permission for use of photos with child's image on printed materials. No permission for use on the parish website or social media accounts. Deny: No permission to print or post photos or video with child's image for using outside the parish. Please fill out this field.
- COMMUNICATION RELEASE
  
  I do hereby grant permission to Saint Alphonsus Liguori Catholic Church to call or text my child(ren) in order to remind, update, or clarify questions about events and youth ministry happenings.
- Please choose one. Permission Granted Permission NOT Granted
REGISTRATION FEES & PAYMENT
- 4:twelve (grades 7 - 8): $60
- Antioch (high school): $60
- Confirmation: $75
Payment Options Pay Online Mail a Check
If finances are an issue, please contact us and we can work through that together!
Please feel free to ask questions and/or leave comments below.
Confirmation Email REQUIRED Please fill out this field. Please enter an email address.

Submit

Youth Ministry Registration

Thank you for choosing to register your child for youth ministry!

4:twelve

Antioch

PARENT/GUARDIAN INFORMATION