Youth Ministry | Life Teen Registration - Nativity Catholic Church

How many high school teens* are you registering for Life Teen Youth Ministry?

* Attending high school for the 2024-2025 school year.

Child 1: Information

Date of Birth(Required)

Cell Phone for Child 1(Required)

Do not enter a parent's phone number here. Click the box below if you do not want to list your child's cell or if they do not have one.

Email for Child 1(Required)

Do not enter a parent's email here. Click the box below if you do not want to list your child's email or if they do not have one.

Name of High School(Required)

Primary or Preferred Health Provider(Required)

Health Provider Phone(Required)

Health Insurance Company(Required)

Policy Number(Required)

Diocesan Requirement - for emergency purposes only.

Please list any medical conditions or allergies that may affect your child's involvement in this program.

Comments

Please share anything you'd like us to know about your child and their participation in this program.

Child 2: Information

Date of Birth(Required)

Cell Phone for Child 2(Required)

Do not enter a parent's phone number here. Click the box below if you do not want to list your child's cell or if they do not have one.

Email for Child 2(Required)

Do not enter a parent's email here. Click the box below if you do not want to list your child's email or if they do not have one.

Name of High School(Required)

Primary or Preferred Health Provider(Required)

Health Provider Phone(Required)

Health Insurance Company(Required)

Policy Number(Required)

Diocesan Requirement - for emergency purposes only.

Please list any medical conditions or allergies that may affect your child's involvement in this program.

Comments

Please share anything you'd like us to know about your child and their participation in this program.

Child 3: Information

Date of Birth(Required)

Cell Phone for Child 3(Required)

Do not enter a parent's phone number here. Click the box below if you do not want to list your child's cell or if they do not have one.

Email for Child 3(Required)

Do not enter a parent's email here. Click the box below if you do not want to list your child's email or if they do not have one.

Name of High School(Required)

Primary or Preferred Health Provider(Required)

Health Provider Phone(Required)

Health Insurance Company(Required)

Policy Number(Required)

Diocesan Requirement - for emergency purposes only.

Please list any medical conditions or allergies that may affect your child's involvement in this program.

Comments

Please share anything you'd like us to know about your child and their participation in this program.

Youth Ministry | Life Teen Registration

Child 1: Information

Child 2: Information

Child 3: Information

Parent / Guardian Information

Parent / Guardian Information

Parental Permissions and Consents