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Shine Registration - Middle School Programs
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Youth Registration Information
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First Name
Last Name

First Name
Last Name
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
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Sacramental Information
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Parent/Legal Guardian Information
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First Name
Last Name
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First Name
Last Name
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Local Emergency Contact (Other than parent/guardian)
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First Name
Last Name
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Medical Information
THIS INFORMATION WILL BE KEPT CONFIDENTIAL. Please provide the medical information below. It will be kept in your son/daughter's records for use by Youth Faith Formation in case of a necessary medical situation.
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Please specify prescription and over the counter medications, dosage and frequency.
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learning and/or physical needs and/or medical conditions
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ex. foods, dyes , latex, medications, or put Not Available (N/A)
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Please describe or put Not Available (N/A)
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Please describe or put Not Available (N/A)
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Please describe or put Not Available (N/A)
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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.

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Consent and Liability Waiver

I grant permission for my child to participate in St. Michael Youth Faith Formation to be held October 1, 2017 - December 31, 2018.  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. 

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Parent Volunteers
We love our families! Please check as many as possible!
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Payment Info