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Spring 2021 Youth Group Registration
If you have multiple students, please fill out the form once for each student.
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* Indicates required question
Student Name
*
Your answer
Grade
*
6
7
8
9
10
11
12
School
*
Your answer
Parent/Guardian Name(s)
*
Your answer
Parent/Guardian Phone Number 1
*
Your answer
Parent/Guardian Phone Number 2
Your answer
Parent/Guardian Email 1
*
Your answer
Parent/Guardian Email 2
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone Number
*
Your answer
Student Medical Conditions
*
Your answer
Student Medicines
*
Your answer
If you will have someone besides a parent picking your child(ren) up from youth group, please indicate who
Your answer
How will you get us the COVID-19 consent form? *if you have already signed one for your child(ren), you do not need to sign another one*
*
Print, sign, scan, and email to
jessicalemoine@divinemercysm.org
Print, sign, and drop off at office at 695 College Avenue, South Milwaukee, WI 53172
Print, sign, and mail to office at 695 College Avenue, South Milwaukee, WI 53172
Sign when dropping off student(s)
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