LifeTeen Registration Form

Please use this from to register your child for High School Youth Group (Lifeteen). When you click SUBMIT, you will be redirected to fill out our Annual Media Release Form – this lets us know if we are allowed to take pictures of your child or not. If you have any questions, please contact our Director of Youth Ministry, Rita O’Grady, at rogrady@stclarecc.org.

CAPTCHA
Teen's Name*
First Last
Teen Cell Phone
Teen Email*
Age*
Please enter a number from 13 to 19.
Date of Birth*
MM slash DD slash YYYY
T-Shirt Size*
School*
Grade*
Please enter a number from 9 to 12.
Do you have any food or drug allergies?*
- Yes
- No
Please list any food or drug allergies.*
Do you have any medical conditions?*
- Yes
- No
Please list medical conditions.*
Is there anything else we should know?*
Address*
Street Address Address Line 2 City State ZIP Code
Mother's Name*
First Last
Mother's Cell*
Mother's Email*
Email Usage*
- Regular Updates
- Urgent Only
Father's Name*
First Last
Father's Cell*
Father's Email*
Email Usage*
- Regular Updates
- Urgent Only
Emergency Contact (other than parent)*
First Last
Emergency Contact Relationship to Teen
Emergency Contact Cell*