Middle School Youth Group &lt;div&gt; &lt;span&gt;Online Registration&lt;/span&gt; &lt;/div&gt;

Date REQUIRED Please fill out this field. Please enter a date.

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name 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.

Email REQUIRED Please fill out this field. Please enter an email address.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Parent Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Date of Birth Please enter valid data.

School Please enter valid data.

Grade 6th 7th 8th

Father's First/Last Name Please enter valid data.

Mother's First/Last Name Please enter valid data.

Guardian/Stepfather's First/Last Name Please enter valid data.

Guardian/Stepmother's First/Last Name Please enter valid data.

Whom do you live with? Mother Father Stepmother Stepfather Guardian/s Other

What Parish is your family registered in? Please enter valid data.

Please check all of the sacraments you have received: Baptism Reconciliation/Confession Communion Confirmation All of the above

List talents/hobbies/interests:

I Agree Please select this field.

Middle School Youth Group
Online Registration