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

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 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 Please enter a phone number.

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!

Life Teen Registration

REGISTRATION FOR life teen

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

parents - read the following documents

LIFE TEEN
Registration Form

PARENTAL PERMISSIONS AND MEDICAL RELEASE FORM

Annual Medical Release Items

REGISTRATION INFO

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