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LIFE TEEN REGISTRATION FORM 2017-2018

JOIN US AS WE KICK OFF THE YEAR!

WHEN: SUNDAY, SEPTEMBER 10, 2017
NEW TIME: 3:30 PM to 5:30 PM; Mass at 6 PM
LOCATION: St. Anthony Parish Hall

FOR MORE INFORMATION, CONTACT: KATHERINE CASTRO AT 361-387-2774

TEEN INFORMATION

Name

First Name*

Last Name*

Date of Birth

Required* //

Address

Street 1*

Street 2

City*

State*

Zip*

Phone

Required* --

Do you receive text messages?
Required*

	Yes
	No

Name of High School Attending

Required*

Grade Level
Required*

	9th
	10th
	11th
	12th

Do you need any Sacraments?
Required*

(Click on the ones you need)*

	I have all my Sacraments
	Baptism
	Confession
	Communion
	Confirmation

GIRLS: Will you be celebrating your 15th or 16th Birthday with a Mass at St. Anthony?

	Yes
	No

PARENT/GUARDIAN INFORMATION

Dad's Name

First Name

Last Name

Dad's Phone

Mom's Name

First Name

Last Name

Mom's Phone

Does your Mom receive text messages?
Required*

	Yes
	No

Name of Legal Guardian

First Name

Last Name

Legal Guardian's Phone

Does your Legal Guardian receive text messages?

	Yes
	No

For Security Purposes

Parent/Guardian Signature: I acknowledge that as the parent/guardian, this information will be submitted to the Parish for use in Registration
Required*

	Yes
	No

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LIFE TEEN REGISTRATION FORM 2017-2018

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