Student's First Name (or preferred nickname)required

Last Namerequired

Student's Email Address (optional)

Student Cell Phone (optional)

Class Yearrequired

School Name

Will you attend the 10/17 event?

Yes No

Does the student have any allergies or medical needs? (If none, type "None")required

Do you have another Gr. 7-12 student?*

No Yes

Student's First Name (or preferred nickname)required

Last Namerequired

Student 2's Email Address (optional)

Student 2 Cell Phone (optional)

Class Yearrequired

School Name

Does the student have any allergies or medical needs? (If none, type "None")required

Please provide contact information for parent(s) including at least one phone number as an emergency contact.

Mother's Full Name

Mother's Email Address

Mother's Cell Phone

I wish to receive messages by: (check all that apply)

Email No mail - I will monitor parish communications

Father's Full Name

Father's Email Address

Father's Cell Phone

I wish to receive messages by: (check all that apply)

Email No mail - I will monitor parish communications

Consent for Photos Statement*

I give permission for my child to be included in the photographs or recordings made in connection with Little Flower Parish and/or the Archdiocese of Washington according to the guidelines set forth in the Photo and Media Policies as linked on the parish webpage.

Yes No

Note:

Thank you!