Life Teen

Youth 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.

Street Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Date of Birth REQUIRED Please fill out this field. Please enter valid data.

Gender REQUIRED Male Female Please fill out this field.

Age REQUIRED Please fill out this field. Please enter an integer (number).

Grade and School REQUIRED Please fill out this field. Please enter valid data.

T-Shirt Size REQUIRED Please fill out this field. Please enter valid data.

Sacraments Received REQUIRED Baptism First Reconciliation First Communion Confirmation Please fill out this field.

Student entering Confirmation Prep? REQUIRED Yes No Please fill out this field.

May we contact you via Facebook/Instagram? REQUIRED Yes No Please fill out this field.

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.

Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Email REQUIRED Please fill out this field. Please enter an email address.

Home Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Work Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Emergency Contact 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.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Relationship to Youth REQUIRED Please fill out this field. Please enter valid data.

Youth's Medical Information

Participant's Allergies (including medicine and food) REQUIRED Please fill out this field. Please enter valid data.

Participant's Chronic Medical Concerns (diabetes, epilepsy, etc.) REQUIRED Please fill out this field. Please enter valid data.

Participant's Other Physical Reactions (if any) REQUIRED Please fill out this field. Please enter valid data.

Please submit with $40 registration fee per child (checks made out to “St. Augustine Catholic Church” with Life Teen in the memo line) to:

St. Augustine Catholic Church
1738 West University Ave.
Gainesville, FL 32603

Life Teen

Documents

Life Teen Photos

Life Teen at St. Augustine Registration