St. Joseph Catholic Church

St. Louis Mission Chapel

High School Youth Group 2023/2024

- Catechesis

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- CCD Student Name REQUIRED Please fill out this field. Please enter valid data.
- Age REQUIRED Please fill out this field. Please enter valid data.
- DOB REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Please fill out this field.
- Has your child made their First Communion? REQUIRED Please fill out this field.
- Name of the school your child is attending REQUIRED Please fill out this field. Please enter valid data.
- What grade will your child be in this upcoming school year? REQUIRED Please fill out this field. Please enter valid data.
- If applicable, list any special needs your child may have (learning/behavioral disorders)
- If applicable, list any medical information we may need to be aware of (allergies)
- List any siblings already in our CCD program
- Are you a registered parishioner of St. Joseph Church / St. Louis Chapel? REQUIRED Please fill out this field.
- Father / Guardian's contact information
  
  First and last name REQUIRED Please fill out this field. Please enter valid data.
  
  cell phone REQUIRED Please fill out this field. Please enter valid data.
  
  e-mail Please enter valid data.
- Mother / Guardian's contact information
  
  First and last name REQUIRED Please fill out this field. Please enter valid data.
  
  cell phone REQUIRED Please fill out this field. Please enter valid data.
  
  email address (for contact and reminder purposes only) REQUIRED Please fill out this field. Please enter valid data.
- Mailing address REQUIRED Please fill out this field.
- Emergency contact #1
  
  Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone number REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to child REQUIRED Please fill out this field. Please enter valid data.
- Emergency contact #2
  
  Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone number REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to child REQUIRED Please fill out this field. Please enter valid data.
- Payment amount REQUIRED Please fill out this field.
- By checking the box below you agree that your child may receive a Safe Environment lesson at least once this school year. This type of lesson is designed to help educate your child about what a safe environment is and how to recognize situations which may be harmful.
  I Agree Please select this field.
- By checking the box below you hereby grant permission to St. Joseph Catholic Church and St. Louis Mission Chapel (Parish), its representatives and employees, the right to take photographs and videos of my child at any and all activities associated with the Parish, to be used for promotional purposes. I authorize the Parish to copyright, use, and publish the same in print and/or electronically. I further agree that the Parish may use such photographs and videos without restriction for advertising, trade, promotion, or any other lawful purposes.
  I Agree Please select this field.
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