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St. Mary's Youth Center Registration

- Faith Formation

The maximum number of form submissions has been reached. This form is currently not available.
- Please submit one form per student.
  
  PLEASE NOTE: Upon submission of this form, you will receive a message with a link to pay the fee for this registration online.
- Choose a Program
  
  Which program will your child attend? REQUIRED Please fill out this field.
- Student Information
  
  Student's First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of birth (mo/day/year) REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade in SEPT. 2024 REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  School REQUIRED Please fill out this field. Please enter valid data.
  
  Does your child speak English? REQUIRED Please fill out this field.
  
  Does your child have special needs? If yes, what is the diagnosis? Please enter valid data.
  
  Does your child have allergies? If yes, what are they? REQUIRED Please fill out this field. Please enter valid data.
  
  Is your child currently enrolled in a Sacramental preparation class? REQUIRED Please fill out this field.
  
  Has your child been baptized? REQUIRED Please fill out this field.
  
  Where? Please enter valid data.
  
  Has your child received their First Communion? REQUIRED Please fill out this field.
  
  Where? Please enter valid data.
  
  Has your child been confirmed? REQUIRED Please fill out this field.
  
  Where? Please enter valid data.
- Parent/Guardian Information
  
  Parent/Guardian (First and Last Name) REQUIRED Please fill out this field. Please enter valid data.
  
  Parent's Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Parent's Email REQUIRED Please fill out this field. Please enter an email address.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  Address Line 2 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.
- Emergency Contact
  
  Emergency Contact 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.
- I give permission for St. Mary of the Assumption Parish Youth Center to take pictures of my child to be published on the Parish Website and/or in the Church Bulletin. REQUIRED Please fill out this field.
- Fee
  
  The program has a donation of $60 per child per semester. The donation covers one semester and can be paid in installments. When you submit this form, you will be able to click a link to pay the fee online. You can also bring payment to the office or to the program.
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