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    Event dates ‘17/’18

    October 7 – “God Knows Me”
    November 18 – “God Hears Me”
    January 13 – “God Strengthens Me”
    March 10 – “God Loves Me”
    May 12 – “God Sends Me”

    Family Last Name:*

    Address:*

    City:*

    State:*

    Zip:*

    Email:*

    Home Phone:*

    Father's Info:

    First/Last Name:
    Cell Phone:
    Religion:

    Mother's Info:

    First/Last Name:
    Cell Phone:
    Religion:

    Child’s Name:* (last, first, middle)

    Gender:* MaleFemale

    Grade in September 2017:*

    Birthdate:*

    School your child is attending:* (last, first, middle)

    Please note that St. Isaac Jogues Youth Ministry will use both email and texting to communicate cancelations, date changes, upcoming events, etc. Please be sure to supply an accurate phone and e-mail address that you can check regularly.

    We welcome children with disabilities

    Registration Information for Elementary School Youth Ministry

    A materials fee payment should accompany this registration form. Cost should not deter anyone from registering their child/children. If this is a concern, please call the Youth Ministry Office, and we will make other arrangements. There is a program fee of $25 per child. This year, we are continuing to use a payment plan option. You may choose to make five equal payments (at each event), or make one lump payment ($20).

    Please check your preference:
    1 payment of $20 (save $5)5 payments of $5

    Pick-up and Carpooling Information:

    Please list the name of another person who you give permission to pick up your child(ren) during the year.

    Name:

    Relationship:

    Name:

    Relationship:

    Emergency and Medical information

    ***This section must be completely filled out***

    Please provide a phone number where you can be reached should an emergency occur during session time if different from home:*

    If you cannot be reached, list the name and phone number of someone you would authorize in such an emergency.

    Name:*

    Phone:*

    Relation to child/children:*

    Do your child/children have any allergies or chronic health conditions of which we should be aware?

    Are there any unique styles of learning which your child’s catechist should be aware? Ways we can best help your child to learn?

    AT TIMES PHOTOS OF CHILDREN PARTICIPATING IN THE RELIGIOUS ED PROGRAMS MAY BE USED ON BULLETIN BOARDS AND ON THE WEB SITE OR SOCIAL MEDIA. (CHILDREN WOULD NOT BE IDENTIFIED WITHOUT SPECIFIC WRITTEN CONSENT) IF YOU DON’T WANT YOUR CHILD PHOTOGRAPHED PLEASE NOTIFY THE OFFICE OF YOUTH MINISTRY IN WRITING AND SUBMIT ALONG WITH THIS REGISTRATION FORM.

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