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Life Teen Registration

- Religious Education

Life teen registration form
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- We are happy you are registering your student(s) for the 2021/2022 Life Teen school year. Its shaping up to be a great season.
  
  Step One
  Complete the full Online Registration Form (below). It includes the ability to register up to 3 students from one household. You can pay online by using a checking account or debit/credit card. (Note: the ability to pay will never be a factor in whether a teen can attend. Please contact Deacon Bill Shea if financial payments would be helpful.)
  
  Step Two
  Print the attached 'Participation/Release' Forms, complete, sign and return both forms to the Life Teen Kickoff party on Sept. 19th at the Church.
  
  Parent Guardian Form (child under 18)
  
  Adult Participation Form (18 or older)
  
  If you have any questions regarding our Life Teen program contact us by email at lifeteen@stjosephscharlton.com.
  
  Thanks!
  
  Deacon Bill Shea - 508-248-7862 - deaconbill@stjosephscharlton.com
  Sarah Stone - 774-230-8324 - sastone1614@gmail.com
- How many students are you Registering? REQUIRED Please fill out this field.
  
  Student 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student Cell Phone Number (555-555-5555) Please enter a phone number.
  
  Student Email Please enter an email address.
  
  Street Address 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.
  
  Student Date of Birth (mm-dd-yyyy) REQUIRED Please fill out this field. Please enter valid data.
  
  School Attending in the Fall REQUIRED Please fill out this field. Please enter valid data.
  
  Grade? REQUIRED Please fill out this field.
  
  Any clubs, sports or events this student is involved in?
  
  Any food or skin allergies?
  
  Any other information we should know about this student?
  
  If you want, name 2 friends you would like to possibly be grouped with, they must be in your same grade.
  
  Student 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student Cell Phone Number (555-555-5555) Please enter a phone number.
  
  Student Email Please enter an email address.
  
  Street Address 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.
  
  Student Date of Birth (mm-dd-yyyy) REQUIRED Please fill out this field. Please enter valid data.
  
  School Attending in the Fall REQUIRED Please fill out this field. Please enter valid data.
  
  Grade? REQUIRED Please fill out this field.
  
  Any clubs, sports or events this student is involved in?
  
  Any food or skin allergies?
  
  Any other information we should know about this student?
  
  If you want, name 2 friends you would like to possibly be grouped with, they must be in your same grade.
  
  Student 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student Cell Phone Number (555-555-5555) Please enter a phone number.
  
  Student Email Please enter an email address.
  
  Street Address 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.
  
  Student Date of Birth (mm-dd-yyyy) REQUIRED Please fill out this field. Please enter valid data.
  
  School Attending in the Fall REQUIRED Please fill out this field. Please enter valid data.
  
  Grade? REQUIRED Please fill out this field.
  
  Any clubs, sports or events this student is involved in?
  
  Any food or skin allergies?
  
  Any other information we should know about this student?
  
  If you want, name 2 friends you would like to possibly be grouped with, they must be in your same grade.
- Parent/Guardian 1 FIRST Name REQUIRED Please fill out this field. Please enter valid data.
- Parent/Guardian 1 LAST Name REQUIRED Please fill out this field. Please enter valid data.
- Parent/Guardian 1 Cell Phone (555-555-5555) 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 FIRST Name (if applicable) Please enter valid data.
- Parent/Guardian 2 LAST Name (if applicable) Please enter valid data.
- Parent/Guardian 2 Cell Phone (555-555-5555) Please enter a phone number.
- Parent/Guardian 2 Email Please enter an email address.
- Release/Consent
  By choosing this checkbox, I agree that I have read, understand and agree to the information on the Release and Consent Form that is available on this website and at the church. My child also agrees to abide by all the rules set forth by the Life Teen director, St. Joseph's Church, Chaperones and Core members and the Diocese of Worcester will not be held liable if my child fails to cooperate with the stated regulations.
  I agree. No, I will print and complete the form and bring Sept 19th.
- Email to send confirmation Please enter an email address.
- Life Teen Student (9th & 10th grade)125.0
- Confirmation Candidate 11th grade - (additional $75.)
  75.0 – Yes
Total:

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St.Joseph's Catholic Church

10 H. Putnam Rd. Ext. Charlton, MA

Life Teen Registration

Life teen registration form