| Registration Form |
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![](3D"RegistrationForm2009-2010_files/image002.jpg")
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| 2009
- 2010 School Year |
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| Student Information: |
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| Student #1 |
First Name: |
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Last Name: |
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Nickname: |
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Gender: M F |
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| Birthdate: |
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School: |
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Grade: 9 10 11 12 |
T-sh=
irt
size: AS AM AL AXL A2XL |
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| St=
udent's
E-mail Address: |
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Student's Cell Phone #: |
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| Address: |
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City, State, Zip: |
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| Baptized Catholic? ___ yes ___ no Confirmed? ___yes ___no Member of what parish?
_________________________________________ |
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| Any
special needs we need to be aware of?&nb=
sp;
(medical, educational, emotional, allergies, medications, etc.)
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| Student #2 |
First Name: |
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Last Name: |
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Nickname: |
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Gender: M F |
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| Birthdate: |
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School: |
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Grade: 9 10 11 12 |
T-shirt
size: AS AM AL AXL A2XL |
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| St=
udent's
E-mail Address: |
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Student's Cell Phone #: |
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| Address: |
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City, State, Zip: |
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| Baptized Catholic?&nbs=
p;
___ yes ___ no Confirmed? ___yes ___no Member of what parish?
__________________________________________ |
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y special
needs we need to be aware of?
(medical, educational, emotional, allergies, medications, etc.)
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| Parent Information: |
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| Father's
Full Name |
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Father's E-mail=
address: |
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| Father's
Address (if different than above): |
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| Father's
Home Phone: |
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Work=
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Cell: |
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| Mother's
Full Name |
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Mother's E-mail address: |
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| Mother's
Address (if different than above): |
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| Mother's
Home Phone: |
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Work=
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Cell: |
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case of emergency please contact (please list name, relationship, and con=
tact
information): |
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| Program Information: |
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![](3D"RegistrationForm2009-2010_files/image004.gif")
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Annual Registration Fees of $50 requested at time of
registration. This fee cove=
rs
cost of Life Teen t-shirt, meal at each Life Night, Supplies for Life Nig=
ht
activities. Additional fees=
may
be requested for special events such as retreats and socials on an as-nee=
ded
basis. |
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No student will ever be turned away for lack of funds. Scholarships available. Contact Lisa Hunke at 380-5643 or
Lcthunke@msn.com for more information. |
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Volunteers are essential to the success of this program. Parents, please mark any area in=
which
you would be willing to help with this ministry: |
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Core Team Membe=
r |
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Substitute Core=
Member |
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Environment Des=
ign |
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Food Preparatio=
n /
Service |
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Retreat Planning |
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Photography |
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Videography |
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Financial Support |
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Promotions |
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I would like to=
sponsor a
high school youth at Life Teen by donating: ____$10 ____$20 ____$30 ____Other: |
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Information about Life Teen will be transmitted throughout t=
he
year via email and also on the Life Teen website at www.life
teenofwp.com. Please make s=
ure
the information we have on file is current at all times. |
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The
Life Teen / Edge programs are centered around the Eucharist. Attending Mass is a very importa=
nt
part of this program. We wo=
uld
like to invite all students to attend the Life Teen Mass as a group on Su=
nday
nights at St. Marys at 5:00. Pews
are reserved up front for students to sit together for this Mass. Please make a commitment to atte=
nding
this Mass to enhance spiritual development within the Life Teen program.<=
span
style=3D'mso-spacerun:yes'> |
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| Photo Release: |
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| Please
check all that apply and sign/date below: |
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I hereby grant permission for my child to be photographed an=
d/or
videotaped during Life Teen activities and events. I understand that my child may d=
ecline
to be photographed and/or videotaped at any time. |
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I further grant permission for the resulting photographs and=
/or
videotaped footage to be edited, if necessary, and then published (including we=
b site
publications) and/or broadcast for the purpose of promoting the Life Teen
and/or youth programs at and in the vicinity of St. Mary’s parish, =
West
Point, Nebraska. |
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I hereby decline to grant permission for my child to be
photographed and/or videotaped during Life Teen activities and events.&=
nbsp;
I have instructed my child to decline to be photographed and/or
videotaped at all times. I =
have
further instructed my child to notify Life Teen coordinators and/or Core Team Members that he/she may no=
t be
photographed and or videotaped under any circumstances. |
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| Parent’s Name (PLEASE
PRINT) |
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Date |
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| Parent’s Signature |
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