Life Teen Registration

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REGISTRATION FOR life teen

AFTER READING THE INFORMATION BELOW
SCROLL DOWN A NUMBER OF SCREENS FOR THE
ONLINE REGISTRATION FORM.

Contact:
Lisa Fiamingo, Director of Youth Ministry 770-516-9699 x232
lfiamingo@saintmichaelcc.org

Who can attend Life Teen? Teens who are in high school.
How long is the program? Life teen begins in mid-August and ends in early May
What is the format? We meet once a week.
When and where do the teens meet? We meet in the Family Center on Sundays from 6:30pm-9:00pm. We have dinner followed by our youth program.
How much does it cost? $40 per teen and we also ask each parent to consider volunteering to cook or to make a $50 donation per family for the year for food.
Is Confirmation Preparation part of the Life Teen program? No. Confirmation Prep is a separate program. Registration and information is found here: Confirmation Preparation
parents - read the following documents

Parents: Please read the following documents. In the registration below you will be required to give your permission or not, your "signed" authorization, and today's date for the following items:

FLOCKNOTE Consent to Email & Text Teens Safe Environment approved. English CLICK HERE for more information about FLOCKNOTE & Teens
Annual Media ReleaseAnnual Medical Release
The maximum number of form submissions has been reached. This form is currently not available.
- LIFE TEEN
  Registration Form
  
  WORKS BEST ON A LAPTOP
- Are you currently registered with our parish? REQUIRED Yes No. If you'd like to register for the parish complete and submit a Parish Registration Form. (see top of this page) https://www.saintmichaelcc.org/parish-registration Please fill out this field.
- ========================================================
- PARENTAL PERMISSIONS AND MEDICAL RELEASE FORM
- PARENT: I hereby grant permission for St. Michael the Archangel to contact my Teen(s), as listed below, via Flocknote for internal or external communications. REQUIRED YES NO - I do not want my Teen contacted. Please fill out this field.
- PARENT: Do you give permission for the Media Release Statement. REQUIRED Please fill out this field.
- Annual Medical Release Items
- Medical/Hospital Insurance Carrier REQUIRED Please fill out this field. Please enter valid data.
- Name of Policy Holder REQUIRED Please fill out this field. Please enter valid data.
- Relation to Participant REQUIRED Please fill out this field. Please enter valid data.
- Policy Number REQUIRED Please fill out this field. Please enter valid data.
- Group Number REQUIRED Please fill out this field. Please enter valid data.
- List any health problems/limitations that we need to be aware of:
- Other allergies/reactions (food, plants, insects, etc.)
- My child is taking the following medication(s); list name of medication, dosage and reason for use
- Entering my full name below is the equivalent of my signed authorization as the legal parent or guardian of the Teen(s) being registered and that I have read the above documents. REQUIRED Please fill out this field. Please enter valid data.
- Today's Date REQUIRED Please fill out this field. Please enter a date.
- ========================================================
- REGISTRATION INFO
- Family Last Name REQUIRED Please fill out this field. Please enter valid data.
- Emergency Contact: First and Last Name of a PARENT (this will be used for Flocknote): REQUIRED Please fill out this field. Please enter valid data.
- Email used for all communications (this will be used for Flocknote): REQUIRED Please fill out this field. Please enter an email address.
- Cell Phone used for all communications (this will be used for Flocknote): REQUIRED Maximum 20 characters
  Use cell phone # if no home phone. This number will be used for class cancellation and other important reminders.
  Please fill out this field. Please enter a phone number.
- 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.
- I would like to receive emails in this language: REQUIRED Please fill out this field.
- Father First Name Please enter valid data.
- Father Last Name Please enter valid data.
- Father Email Please enter an email address.
- Father Cell Phone Maximum 20 characters Please enter a phone number.
- Mother First Name Please enter valid data.
- Mother Last Name Please enter valid data.
- Mother Email Please enter an email address.
- Mother Cell Number Maximum 20 characters Please enter a phone number.
- Indicate how many Teens you are registering for LIFE TEEN REQUIRED Please fill out this field.
  
  Teen 1
  
  Teen's Gender REQUIRED Female Male Please fill out this field.
  
  Teen's First Name (Baptismal-not nickname) REQUIRED Please fill out this field. Please enter valid data.
  
  Teen's Middle Name Please enter valid data.
  
  Teen's Nickname Please enter valid data.
  
  Teen's Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Teen's Birthdate MM/DD/YYYY REQUIRED Please fill out this field. Please enter a date.
  
  Teen's Age this August REQUIRED Please fill out this field.
  
  Teen's Grade this August REQUIRED Please fill out this field.
  
  Email of Teen (do not use Parent email - use school email if no other is available): Please enter an email address.
  
  Cell Phone Number of Teen (DO NOT use Parent cell phone - enter all zero's if Teen does not have a cell phone): REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  If Teen is NOT Catholic, type their denomination Please enter valid data.
  
  BAPTISM: REQUIRED Yes, Baptized Catholic Yes, Baptized in another Christian faith No, not Baptized Please fill out this field.
  
  FIRST HOLY COMMUNION: REQUIRED Yes, received in a Roman Catholic Church No Please fill out this field.
  
  Confirmation? REQUIRED Yes, Confirmed in a Roman Catholic Church No, has not received the Sacrament Please fill out this field.
  
  Teen 2
  
  Teen's Gender REQUIRED Female Male Please fill out this field.
  
  Teen's First Name (Baptismal-not nickname) REQUIRED Please fill out this field. Please enter valid data.
  
  Teen's Middle Name Please enter valid data.
  
  Teen's Nickname Please enter valid data.
  
  Teen's Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Teen's Birthdate MM/DD/YYYY REQUIRED Please fill out this field. Please enter a date.
  
  Teen's Age this August REQUIRED Please fill out this field.
  
  Teen's Grade this August REQUIRED Please fill out this field.
  
  Email of Teen (do not use Parent email - use school email if no other is available): Please enter an email address.
  
  Cell Phone Number of Teen (DO NOT use Parent cell phone - enter all zero's if Teen does not have a cell phone): REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  If Teen is NOT Catholic, type their denomination Please enter valid data.
  
  BAPTISM: REQUIRED Yes, Baptized Catholic Yes, Baptized in another Christian faith No, not Baptized Please fill out this field.
  
  FIRST HOLY COMMUNION: REQUIRED Yes, received in a Roman Catholic Church No Please fill out this field.
  
  Confirmation? REQUIRED Yes, Confirmed in a Roman Catholic Church No, has not received the Sacrament Please fill out this field.
  
  Teen 3
  
  Teen's Gender REQUIRED Female Male Please fill out this field.
  
  Teen's First Name (Baptismal-not nickname) REQUIRED Please fill out this field. Please enter valid data.
  
  Teen's Middle Name Please enter valid data.
  
  Teen's Nickname Please enter valid data.
  
  Teen's Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Teen's Birthdate MM/DD/YYYY REQUIRED Please fill out this field. Please enter a date.
  
  Teen's Age this August REQUIRED Please fill out this field.
  
  Teen's Grade this August REQUIRED Please fill out this field.
  
  Email of Teen (do not use Parent email - use school email if no other is available): Please enter an email address.
  
  Cell Phone Number of Teen (DO NOT use Parent cell phone - enter all zero's if Teen does not have a cell phone): REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  If Teen is NOT Catholic, type their denomination Please enter valid data.
  
  BAPTISM: REQUIRED Yes, Baptized Catholic Yes, Baptized in another Christian faith No, not Baptized Please fill out this field.
  
  FIRST HOLY COMMUNION: REQUIRED Yes, received in a Roman Catholic Church No Please fill out this field.
  
  Confirmation? REQUIRED Yes, Confirmed in a Roman Catholic Church No, has not received the Sacrament Please fill out this field.
  
  Teen 4
  
  Teen's Gender REQUIRED Female Male Please fill out this field.
  
  Teen's First Name (Baptismal-not nickname) REQUIRED Please fill out this field. Please enter valid data.
  
  Teen's Middle Name Please enter valid data.
  
  Teen's Nickname Please enter valid data.
  
  Teen's Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Teen's Birthdate MM/DD/YYYY REQUIRED Please fill out this field. Please enter a date.
  
  Teen's Age this August REQUIRED Please fill out this field.
  
  Teen's Grade this August REQUIRED Please fill out this field.
  
  Email of Teen (do not use Parent email - use school email if no other is available): Please enter an email address.
  
  Cell Phone Number of Teen (DO NOT use Parent cell phone - enter all zero's if Teen does not have a cell phone): REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  If Teen is NOT Catholic, type their denomination Please enter valid data.
  
  BAPTISM: REQUIRED Yes, Baptized Catholic Yes, Baptized in another Christian faith No, not Baptized Please fill out this field.
  
  FIRST HOLY COMMUNION: REQUIRED Yes, received in a Roman Catholic Church No Please fill out this field.
  
  Confirmation? REQUIRED Yes, Confirmed in a Roman Catholic Church No, has not received the Sacrament Please fill out this field.
- LIFE TEEN TUITION:
- Life Teen Annual Fee per student40.0
- How many Teens are you registering for Life Teen? REQUIRED Please fill out this field.
- COOK TEAM: PARENT VOLUNTEERS NEEDED! REQUIRED I would like to help with a Cook Team I am unable to help with a Cook Team. Please fill out this field.
- I am unable to help with a Cook Team so I'd like to donate $50 for food for my teen(s) for the year. 50.0 – Donate
- You MUST click on the "PROCEED TO PAYMENT"
  button for us to receive this registration.
  
  If you do not receive the payment page, please review the above information to insure that all required fields are filled in (any required missing information will be highlighted in RED).
  
  A payment page will then display. Please complete your payment within 10 minutes. You will then receive an E-Catholic email confirming the receipt of your submission and whether or not you paid.
  
  If you do not complete the payment page within 10 minutes, the page will become inactive. If this happens, please wait for an email which will confirm receipt of your submission and also provide a link for payment. Please use this link which is specific to your registration to make your payment.
  
  Thank you!
Total:

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Life Teen Registration

AFTER READING THE INFORMATION BELOW SCROLL DOWN A NUMBER OF SCREENS FOR THE ONLINE REGISTRATION FORM.

LIFE TEEN Registration Form

PARENTAL PERMISSIONS AND MEDICAL RELEASE FORM

Annual Medical Release Items

REGISTRATION INFO

AFTER READING THE INFORMATION BELOW
SCROLL DOWN A NUMBER OF SCREENS FOR THE
ONLINE REGISTRATION FORM.

LIFE TEEN
Registration Form