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St. Elizabeth Fraternus Registration 26-27

- Parish Life

Fraternus - St. Elizabeth Ann Seton
Youth Contact Info and Photo Waiver
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- Youth Information: 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  School that Child Attends REQUIRED Please fill out this field. Please enter valid data.
  
  Grade REQUIRED Please fill out this field. Please enter valid data.
  
  T-Shirt Size REQUIRED Please fill out this field. Please enter valid data.
  
  Home Parish REQUIRED Please fill out this field. Please enter valid data.
- Additional Youth (if applicable): 2
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  School that Student Attends Please enter valid data.
  
  Grade Please enter valid data.
  
  T-Shirt Size Please enter valid data.
- Additional Youth (if applicable): 3
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  School that Student Attends Please enter valid data.
  
  Grade Please enter valid data.
  
  T-Shirt Size Please enter valid data.
- Additional Youth (if applicable): 4
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  School that Student Attends Please enter valid data.
  
  Grade Please enter valid data.
  
  T-Shirt Size Please enter valid data.
- Parent Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent Email REQUIRED Please fill out this field. Please enter an email address.
  
  Parent Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Additional Emergency Contact
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Special Needs
  
  Please describe below any medical information, any special needs or anything else you would like us to be aware of regarding your child. All information will be held in confidence and shared only when vitally necessary.
- Photo and Media Consent Release
  
  St. Elizabeth Ann Seton Catholic Church and/or the Diocese of Fort Wayne-South Bend may use photographs, video or other media of my child for any lawful purposes, including but not limited to such purposes as publicity, illustration, advertising, and Web content. Names of students will not be published.
  
  Select one of these two options REQUIRED I grant permission to the above Consent and Release I DO NOT grant permission to above Consent and Release Please fill out this field.
- Signature
  
  By typing my name and submitting this application, I certify that I am the parent/guardian of the youth who is being registered for Fraternus. REQUIRED I agree Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date Submitted REQUIRED Please fill out this field. Please enter a date.
  
  After clicking Continue, you will be redirected to the Fraternus national website to complete your registration. Both forms must be completed in order for you to be fully registered.
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