Youth Group Registration

Student's Information
Name of the Youth*
First Last
Preferred Name
First
Address*
Street Address Address Line 2 City State ZIP Code
Student's Email*
Student's Cell Phone (Optional)
Date of Birth*
Month
Day
Year
Sacramental Life
- Baptism
- First Holy Communion
- Confirmation
Grade*
- 9th Grade
- 10th Grade
- 11th Grade
- 12th Grade
Name of the School the youth is attending*
Youth Resides with*
- Both Parents
- Mother
- Father
Parents' or Legal Guardian's Information
Father / Guardian*
First Middle Last
Home Phone
Cell Phone
Email
Address (If Different)
Street Address Address Line 2 City State ZIP Code
Mother / Guardian*
First Middle Last
Home Phone
Cell Phone
Email
Address (If Different)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Emergency Contact Information
Name*
First Last
Home Phone
Cell Phone*
Relationship*
- Mother
- Father
Image Disclosure Consent
Permission for Image Disclosure of the Child.*
Please let us know if you authorize or not authorize the use of the image of your child, by the staff or volunteers of the Faith Formation of department of the St Catherine of Siena Parish.
- Yes, I would like to authorize
- No, I do NOT authorize it
Permission for Image Disclosure*
Yes, I DO authorize the Faith Formation department of St. Catherine of Siena Parish, in Kissimmee, FL to take photos, videos or any type of recording of my child to be used in the Parish Bulletin, Parish Website, or any other parish form. I waive from any claims, and release all the staff members, volunteers of St. Catherine of Siena Catholic Church in Kissimmee, FL, and/or the Diocese of Orlando, weather former, future, or current, from any and all claims, actions, cause of actions, suits, costs, expenses, liabilities, or/and damages.
Signature

Youth Group Registration

Student's Information

Parents' or Legal Guardian's Information

Emergency Contact Information

Image Disclosure Consent