St. Stephen the Martyr Parish Youth Ministry Registration 2022-23

St. Stephen the Martyr Parish Youth Ministry

Participant Information for 2022-23

Life Teen (Grades 9-12):

Sundays from 7-9 PM in Gonderinger Parish Center

Edge (Grades 6-8):

Tuesdays from 6:30-8 PM in the SSM Dining Room

Dinner Included. No cost to attend.

What About Wednesdays Discipleship Group (Grades 9-12):

Wednesdays from 7-8:30 PM in the School Library

Additional faith and community building opportunities, such as social events, service opportunities, small groups, or Bible studies, will also be scheduled throughout the year.

Welcome to St. Stephen’s Youth Ministry! Weekly attendance is NOT mandatory (we want participants to come when they can!) and there is NO COST to attend these youth nights.

Permission to participate:
I grant permission for my child(ren) to participate in these youth ministry events that are located on the parish/school site. These activities will take place under the guidance and direction of Archdiocesan parish/campus youth ministers and/or volunteers from parishes/schools.

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Consent to Contact Physician in an Emergency:

In the event that I cannot be reached to make arrangements, I hereby give my consent to St. Stephen the Martyr parish to transport my child to a clinic or hospital and seek treatment.

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Today's Date: April 18, 2024

Questions or concerns? Contact Laura Bogue, Youth Ministry, at 402-861-4509 or at l.bogue@stephen.org.

Please select who will be participating...

Minor(s)
1 Minor 2 Minors 3 Minors 4 Minors 5 Minors More Minors 6 Minors 7 Minors 8 Minors 9 Minors 10 Minors

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Second Participant's Name

First Name*

Last Name*

Second Participant's Date of Birth*

Second Participant's Information

Father's Name:

Father's Cell #:

Mother's Name:

Mother's Cell #:

Youth E-Mail Address, if applicable:

Youth Cell #, if applicable:

What school does your child attend?

What grade will your child be in during the 2022-23 school year?*

6th

7th

8th

9th

10th

11th

12th

Family Health Information:

Does your child have any health concerns or special needs we need to be aware of to ensure a great experience?

Does your child take any medications or have any allergies?

Third Participant's Name

First Name*

Last Name*

Third Participant's Date of Birth*

Third Participant's Information

Father's Name:

Father's Cell #:

Mother's Name:

Mother's Cell #:

Youth E-Mail Address, if applicable:

Youth Cell #, if applicable:

What school does your child attend?

What grade will your child be in during the 2022-23 school year?*

6th

7th

8th

9th

10th

11th

12th

Family Health Information:

Does your child have any health concerns or special needs we need to be aware of to ensure a great experience?

Does your child take any medications or have any allergies?

Fourth Participant's Name

First Name*

Last Name*

Fourth Participant's Date of Birth*

Fourth Participant's Information

Father's Name:

Father's Cell #:

Mother's Name:

Mother's Cell #:

Youth E-Mail Address, if applicable:

Youth Cell #, if applicable:

What school does your child attend?

What grade will your child be in during the 2022-23 school year?*

6th

7th

8th

9th

10th

11th

12th

Family Health Information:

Does your child have any health concerns or special needs we need to be aware of to ensure a great experience?

Does your child take any medications or have any allergies?

Fifth Participant's Name

First Name*

Last Name*

Fifth Participant's Date of Birth*

Fifth Participant's Information

Father's Name:

Father's Cell #:

Mother's Name:

Mother's Cell #:

Youth E-Mail Address, if applicable:

Youth Cell #, if applicable:

What school does your child attend?

What grade will your child be in during the 2022-23 school year?*

6th

7th

8th

9th

10th

11th

12th

Family Health Information:

Does your child have any health concerns or special needs we need to be aware of to ensure a great experience?

Does your child take any medications or have any allergies?

Sixth Participant's Name

First Name*

Last Name*

Sixth Participant's Date of Birth*

Sixth Participant's Information

Father's Name:

Father's Cell #:

Mother's Name:

Mother's Cell #:

Youth E-Mail Address, if applicable:

Youth Cell #, if applicable:

What school does your child attend?

What grade will your child be in during the 2022-23 school year?*

6th

7th

8th

9th

10th

11th

12th

Family Health Information:

Does your child have any health concerns or special needs we need to be aware of to ensure a great experience?

Does your child take any medications or have any allergies?

Seventh Participant's Name

First Name*

Last Name*

Seventh Participant's Date of Birth*

Seventh Participant's Information

Father's Name:

Father's Cell #:

Mother's Name:

Mother's Cell #:

Youth E-Mail Address, if applicable:

Youth Cell #, if applicable:

What school does your child attend?

What grade will your child be in during the 2022-23 school year?*

6th

7th

8th

9th

10th

11th

12th

Family Health Information:

Does your child have any health concerns or special needs we need to be aware of to ensure a great experience?

Does your child take any medications or have any allergies?

Eighth Participant's Name

First Name*

Last Name*

Eighth Participant's Date of Birth*

Eighth Participant's Information

Father's Name:

Father's Cell #:

Mother's Name:

Mother's Cell #:

Youth E-Mail Address, if applicable:

Youth Cell #, if applicable:

What school does your child attend?

What grade will your child be in during the 2022-23 school year?*

6th

7th

8th

9th

10th

11th

12th

Family Health Information:

Does your child have any health concerns or special needs we need to be aware of to ensure a great experience?

Does your child take any medications or have any allergies?

Ninth Participant's Name

First Name*

Last Name*

Ninth Participant's Date of Birth*

Ninth Participant's Information

Father's Name:

Father's Cell #:

Mother's Name:

Mother's Cell #:

Youth E-Mail Address, if applicable:

Youth Cell #, if applicable:

What school does your child attend?

What grade will your child be in during the 2022-23 school year?*

6th

7th

8th

9th

10th

11th

12th

Family Health Information:

Does your child have any health concerns or special needs we need to be aware of to ensure a great experience?

Does your child take any medications or have any allergies?

Tenth Participant's Name

First Name*

Last Name*

Tenth Participant's Date of Birth*

Tenth Participant's Information

Father's Name:

Father's Cell #:

Mother's Name:

Mother's Cell #:

Youth E-Mail Address, if applicable:

Youth Cell #, if applicable:

What school does your child attend?

What grade will your child be in during the 2022-23 school year?*

6th

7th

8th

9th

10th

11th

12th

Family Health Information:

Does your child have any health concerns or special needs we need to be aware of to ensure a great experience?

Does your child take any medications or have any allergies?

Participant's Address

Address Line 1:*

Street address, P.O. box, company name, c/o

Address Line 2:

Apartment, suite, unit, building, floor, etc.

Country:*

City:*

State/Province:*

Zip/Postal:*

Parent or Guardian's Email Address

Email*

Confirm Email*

Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Participation in SSM Youth Ministry On-Line:

Permission to participate in On-Line Ministry:SSM Youth Ministry may occasionally host different on-line events/sessions to continue to connect with, minister to, and share the faith with the youth of our parish. I grant permission for my child(ren) to participate in these youth ministry events that will be carried out through on-line or social media platforms. All on-line communications, class times, chats, etc. will be monitored by safe environment certified adults.*

Yes

Permission to Contact Youth on Cell Phones:

Permission to contact youth: In order to strengthen communication with youth, send updates and reminders regarding youth ministry events, etc., do we have permission to contact your child(ren) through text messages via Flocknote or other similar platforms?*

Yes

Would you like to be included on these additional text message communications? (These messages would be in addition to our parent newsletters, Flocknote updates, etc.)*

Yes

Photo/Video Release:

Permission to use pictures/video: I hereby give St. Stephen the Martyr Parish permission to publish pictures or video of my child/ren on the parish website and social media outlets or in parish publications.*

Yes

Youth Code of Conduct:

YOUTH: I understand that I am a representative of St. Stephen the Martyr Parish and the parish youth program. I will conduct myself in a manner which will reflect a positive image of the parish, the youth program, and myself.*

Yes

Electronic Signature Consent*

By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.

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