St. Thomas Aquinas Parish –
STAYouth Ministry – Registration Form 2008–2009
Junior High (grades 6-8) and Senior High
(grades 9-12)
[Parish
requires one form per participating student]
Student Name: ______________________________________ Birthdate: _____________ Age: _____________
Student Address:
__________________________________________________________________________________
Student Email:
____________________________________________________________________________________
Student Cellular/Mobile Phone
_________________________________
Student’s School
____________________________________ Grade in 2008-09:
_______
Parent(s)/Guardian: _________________________________________________________________________________
Parent(s)/Guardian Address:
__________________________________________________________________________
Parent(s)/Guardian Email: ___________________________________________________________________________
Phone (Mother): Day ______________________ Night _________________ Cell _____________________
Phone (Father): Day _______________________ Night _________________ Cell _____________________
Emergency Contact:
Name: ______________________________________ Relationship: _______________ Phone: _____________
EMERGENCY
INFORMATION AND RELEASE FORM
In the event that no one
can be reached, I authorize the Youth Minister or authorized supervising adult
to seek trained medical help for my child.
I accept responsibility for any incurred expense.
Date: _______________ Signature: _______________________________ Relationship: ____________
Allergies:
_________________________________________________________________________________
Medications:
______________________________________________________________________________
Family Physician / Medical
Group: ____________________________________ Phone __________________
Insurance Company: ________________________________ Policy #: ___________________________
Dentist:
__________________________________________________________ Phone __________________
STUDENT SACRAMENTAL
INFORMATION:
(Baptism & First
Communion required for Sacrament of
|
Sacraments Received: |
Name of Catholic church |
City |
State |
Month/Year |
|
Baptism |
|
|
|
|
|
First Communion |
|
|
|
|
|
Confirmation |
|
|
|
|
Sacrament of
STAYouth Fees(circle one): $100
one student $200 two students $250 three or more students
Fees cover age-specific catechetical and youth ministry materials.
Additional Donation to new STAYouth Activity Fund Amount $______, payable to St. Thomas Aquinas
***SOCIAL*** ***SPIRITUAL*** ***SERVICE***
St. Thomas Aquinas Parish
650-494-2496 Ext. 21
ATTN: Rob Manfrey, STAYouth
Ministry