One moment please...
June 21-23, 2019 Steubenville Lone Star High School Summer Conference
Registration for Steubenville Lone Star June 21-23, 2019
Includes transportation, lodging, admission to the conference, 2 t-shirts to be worn at the conference, dinner on Friday, breakfast, lunch, dinner and late-night snack on Saturday, and Breakfast and lunch on Sunday. We will be departing via Bus at 9:45 am on Friday June 21, 2019. We will returning via bus to St. Michael by 6:00 pm on Sunday June 23, 2019.
Teen Registration Information
*

First Name
Last Name
*
*

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
*

(mm/dd/yyyy)
*

*

*
*

*
Parent/Legal Guardian Information
*

First Name
Last Name
*

*

*

*

First Name
Last Name



Local Emergency Contact (Other than parent/guardian)
*

First Name
Last Name
*

*

Teen Medical Information
THIS INFORMATION WILL BE KEPT CONFIDENTIAL. Please provide the medical information below. It will be kept in your teen's records for use by Youth Faith Formation in case of a necessary medical situation.
*

*

*

*

*

*

Please specify prescription and over the counter medications, dosage and frequency.
*

*

learning and/or physical needs and/or medical conditions
*
Please select one
*

ex. foods, dyes, latex, medications, or put Not Available (N/A)
*

Please describe or put Not Available (N/A)
*

Please describe or put Not Available (N/A)
*

Please describe or put Not Available (N/A)
*

approximate month and year
Video and Photography Consent

As parent/guardian, I understand that promotional pictures and videos (individual and group) will be taken during this event. I give permission for my son’s/daughter’s picture to be used for promotional materials (newsletter, web page, calendars, power point, video etc.) in highlighting the event.

*
Consent and Liability Waiver

I grant permission for my child to participate in St. Michael Youth Faith Formation to be held June 21, 2019 through June 23, 2019.  In consideration of my son’s/daughter’s participation in this event, I agree on behalf of myself, my child named herein, and our heirs, successors, and assigns to indemnify, hold harmless and defend the Archdiocese of Galveston-Houston, the sponsoring parish, its pastor, youth ministry leader, principal, other agents, employees or other representatives associated with the event from any and all injuries, losses or claims arising out of my child’s participation in the event.

In signing this form I certify that all information contained herein is true and accurate to the best of my knowledge. 

*

*

Payment Information
*