Youth Ministry Registration

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

Teen Last Name REQUIRED Please fill out this field. Please enter valid data.

Teen Preferred Name Please enter valid data.

Street Address 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.

Birthdate (00/00/0000) REQUIRED Please fill out this field. Please enter a date.

Age REQUIRED Please fill out this field. Please enter an integer (number).

Sacraments Recieved REQUIRED Baptism Reconciliation Holy Communion Confirmation No Sacraments have been recieved Please fill out this field.

School Registered at for the 2021-2022 school year. REQUIRED Please fill out this field. Please enter valid data.

Grade REQUIRED Please fill out this field. Please enter an integer (number).

Gender Male Female

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

Parent permission is herby granted to send minor-youth text messages corresponding to Youth Ministry at St. John Vianney or the Arch Diocese of Washington.
Please note: Any text that is sent to a teen will also be sent to parents or guardians listed on this form.

I Agree Please select this field.

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

Preferred method we should use to contact your teen? REQUIRED Email Cell Phone Please fill out this field.

Teen's Preferred T-Shirt Size Please enter valid data.

Teen's extracurricular activities or hobbies

Parent/Guardian 1 - Full Name REQUIRED Please fill out this field. Please enter valid data.

Parent/Guardian 1 Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Parent/Guardian 1 Email REQUIRED Please fill out this field. Please enter an email address.

Parent/Guardian 2 Full Name Please enter valid data.

Parent/Guardian 2 Cell Phone Number Please enter a phone number.

Parent or Guardian 2 Email Please enter an email address.

Preferred method we should contact parent(s)/guardian(s)? REQUIRED Email Cell Phone Please fill out this field.

Parent support is crucial in a thriving Youth Ministry! In what ways can you offer to help with at least one thing? REQUIRED Chaperone Outreach/Hospitality Team Worship Team Other I am not interested in volunteering at this time. Please fill out this field.

Please share any medical conditions we should be aware of.

Emergency Contact 1 (Name, Phone Number, Relationship to teen.) REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact 2 (Name, Phone Number, Relationship to teen.) REQUIRED Please fill out this field. Please enter valid data.

Consent for Photos Statement
I hereby grant permission for my child to be included in the photographs, videos and other recording/publications, made in connection with St. John Vianney Catholic Church and/or the Archdiocese of Washington a period of one calendar year. This includes use on our social media channels and website. I understand that once the photo has been published it becomes part of th parish archives and may be used in the future.

I Agree Please select this field.

Liability Statement
I understand there is the possibility/risk of injury and/or loss which my child may sustain while participating in activites during scheduled Youth Ministry events. I also understand that all precautions will be taken to ensure the safety and security of my child at all times during these activities.
I hereby release and agree to hold harmless St. John Vianney Catholic Parish and the Archdiocese of Washington and any of their volunteers, advisors, chaperones, or persons connected with the Parish Youth Ministry program from any liability, claims, damages for person injury, property loss/damage which may result during the course of the Youth Ministry year.

I Agree Please select this field.

Parent Signature (Type Name) and Today's Date REQUIRED Please fill out this field. Please enter valid data.