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Lifeteen Registration

- Lifeteen/Youth Ministry

REGISTRATION FEE: $40
Lifeteen Registration Form
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- Student Information:
  
  Student NAME: REQUIRED Please fill out this field. Please enter valid data.
  
  Grade REQUIRED Please fill out this field.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  E-mail: Please enter valid data.
  
  Birthday REQUIRED Please fill out this field. Please enter valid data.
  
  Teen's Cell Phone Please enter valid data.
- Sacramental Information:
  
  Completed Sacraments: Baptism Eucharist Penance Sacramental Prep NEEDED
  
  Church & City of Baptism REQUIRED Please fill out this field. Please enter valid data.
- Special Requests:
  
  Special Needs (medical, learning, or physical):
  
  Is there a certain small group leader you'd like to request? Please enter valid data.
  
  A Certain friend you'd like in your small group? Or any other group requests? Please enter valid data.
  
  Any other requests for your small group ? Please enter valid data.
  
  Do you need to pay with a payment plan or Need financial assistance? If yes request below Please enter valid data.
- Parent/Guardian Information:
  
  Father's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's name: REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's Maiden Name: REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Cell Phone REQUIRED Please fill out this field. Please enter valid data.
  
  Phone: Please enter valid data.
- Anything else we should know to better serve your teen?
- I hereby give permission to photograph my child for lifeteen events, church website, & bulletin purposes?
  Photographs may be used to put on St. Theodore's Lifeteen Facebook page, church website, & bulletin
  Yes No
Submit