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Edge, LifeTeen, Confirmtion Registration Form

Teen Information
Registering Year?
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Are you registering for Edge (MS), LifeTeen (HS and/or Confirmation?
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Check ALL that apply
Title
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Teen's Full Legal Name
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As on Birth Certificate
Suffix
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Nickname
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Teen's Address
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Teen's E-mail
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Teen's Cell Phone --
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Date of Birth //
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Gender
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Religion
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Grade
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School
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Home Parish
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Sacraments Received
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Church of Baptism
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What Mass do you/your family attend?
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Are you interested in serving with a Youth Mass? If so, which ministry...
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Are you currently any of the following:
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List any job, groups, teams or extracurricular activities that you are involved with during the school year.
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Parent/Guardian Information
Title
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Mother/Guardian Name
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Nickname
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Mother/Guardian Email
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Mother/Guardian Cell Phone --
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Address (if different from Teen's)
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If not Mother, Relationship to Teen
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Title
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Father/Guardian Name
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Suffix
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Nickname
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Father/Guardian E-mail
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Father/Guardian Cell Phone --
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Address (if different from Teen's)
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If not Father, Relationship to the Teen
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Special Needs
Information listed below remains confidential and will only be used for purposesrelatedto assisting the Catechist. It is recommended that parents of children that have special needs also be provided a one on one meeting with the parish catechetical leader to discuss learning needs.
List any educational or behavioral needs (e.g. gifted, dyslexic, ADD, slow reader, IEP, etc.
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Pick-Up Authorization
Please list below those who are authorized byyou to pick-up your child from class/meetings.
Name
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Cell Phone --
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Name
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Cell Phone --
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Other Information
Fees There is a $20 Registration Fee for EACH, Edge, LifeTeen and Confirmation. Fees can be paid by Check (St. Patrick Youth Group), Cash or Online.
Payment Options
*Bring your Registration Form and Fee to Youth Group.
*You can mail Registration Form and Fee to St. Patrick Youth Group, 3350 S. Alameda St., Corpus Christi, TX 78411.
*You can place the Registration form and Fee in an envelope in the Mail Slot located at the bottom right hand side of the Rectory door.
*Registration form may be sent electronically here and Fees can be paid online by going to the St. Patrick Website at www.stpatrickchurchcc.org. Click on the ONLINE GIVING icon at the bottom of the page or the Online Giving Tab at the top of the page. If you do not have an Online Giving account, you will need to create one or click on Quick Give.
Electronic Signature
By typing your name you are stating that the above information is correct and that you agree to all of the above.
Electronic Signature
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Submitting this Form This form will not be sent to the office unless you click on the SUBMIT button at the bottom of this page.
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Office Use Only
Fees Paid
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Date //
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