High School LifeTeen Registration Form
Star of the Sea Catholic Church
2021-2022 High School Religious Education
Life Teen
Sunday 7:00 – 8:30pm
Sign in to Google to save your progress. Learn more
Student Name: *
Student Cell Phone: *
Student Email *
Grade *
School: *
Father’s name: *
Father's Religion: *
Father’s email: *
Father’s cell phone: *
Mother’s name: *
Mother's Religion: *
Mother’s email: *
Mother’s cell phone: *
Communication Preference *
Do both parents reside in the home: yes or no If no, teen resides with : *
My teen has special needs: yes or no If yes, how can we be of assistance?

 *
Post Confirmation teens (all of whom should attend Life Teen) are also eligible to apply for leadership positions. Are you interested? yes or no *
Parents, we need your help during the year. Please check areas that you can help.
Are you VIRTUS trained? Volunteers must participate in VIRTUS training and background check

Clear selection
Are you also requesting the sacrament of Confirmation, please indicate that and also fill out the Sacrament Request Form for Teen Confirmation (must be in 10th or above).

 *
Please be advised that Flocknote will be used for email and text communication.  Parent(s) noted above will be added to Flocknote. All teens will be entered.
High School Release Form                                                                                                    Parish: Star of the Sea Church Phone: 757-428-8547     1404 Pacific Ave, Virginia Beach, VA  23451    
Type of Event: see information for each event to be given out separately
Destination:        see information for each event to be given out separately
Individual in Charge: Coordinator of Christian Formation/ Adult Volunteer Catechists
Transportation: see information for each event to be given out separately
Dates of Trip: see information for each event to be given out separately
Child’s Name *
Date of Birth *
Gender *
Parent(s)/Guardian’s Name *
Street Address *
City *
State *
Zip *
Home Phone *
Cell Phone *
Emergency Contact Name (other than parents) *
Contact Number *
Relationship to Child *
Does your child have allergies? Yes or No  Details: *
Is your child taking any medications? Yes or No Details: *
Is there any other physical or emotional condition of which we need to be aware: Yes or No Please explain: *
As parent/guardian I remain legally responsible for any personal actions taken by the above named minor. I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend the Catholic Diocese of Richmond, Star of the Sea Church, their employees and agents, chaperons, or representatives associated with the event from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the Diocese and/or Star of the Sea, their employees and agents and chaperons, or representatives associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the Diocese and/or Star of the Sea Church I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. In the case of any emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment.  I wish to be advised prior to any further treatment by the hospital or doctor.  In the event of an emergency, if you are unable to reach me at the above numbers I give permission for the noted emergency contact to be notified. I will not hold the Diocese of Richmond and/or Star of the Sea Church responsible for authorizing any medical treatment beyond necessary transportation to the hospital. By typing my name below, I attest that this replaces my handwritten signature. *
I give permission for pictures and/or video of my child (named above) engaged in activities related to Star of the Sea Church to have their pictures posted in publications or websites.  Names of participants will not be used without expressed permission from the parent or guardian.  If neither box is checked below, Star of the Sea assumes you give permission. *
Please type name (signature) for previous question *
Youth Code of BehaviorThe purpose of Life Teen is to provide an environment for young Catholics to learn, grow and understand more about their Catholic Faith by growing in their relationship with Jesus Christ. In order to carry out this mission, we ask each youth to read, sign and follow the Code of Behavior.
I will make every effort to attend Mass weekly.
I will represent the Catholic Christian community through my language, dress and behavior.
I agree to respect the rights and property of others.
I agree to respect Life Teen Core Team leaders
I will participate in all planned activities and small group sessions.
I will not use my cell phone during Life Teen unless instructed by leaders and understand that if I use my phone without permission it will be taken away until the end of the night.
I will not possess any alcohol, non-prescription drugs, fireworks, weapons or knives.
I will not leave the church grounds without adult supervision.
I will build new relationships with my small group members, peers and core team members.
I will refrain from inappropriate touching and verbal harassment.
I will not take part in any form of bullying which includes (one or more students seeking to have power over another student through the use of verbal, physical or emotional harassment, intimidation or isolation).
I will be safe. No horseplay or other potentially harmful actions.
I will help keep the church and classrooms clean and pick up any trash if I see it, even if it is not my own.

YOUTH I have read, understood and agree to follow the Code of Behavior outlined above. I will also encourage other group members to live by these rules. Digital Signature required. *
PARENTS I have read, understood and agree to the Code of Behavior for my son/ daughter. I will actively participate within the life of the Church (attend Sunday Mass weekly, attend Holy Days of Obligation Masses, pray and encourage my family to pray, learn more about my Catholic faith)I will stress the importance of making and attending Mass a priority over other scheduled activities. Digital signature required. *
Payment: After completing your online payment, you MUST return to this form, enter your egiving MEMBER ID# and hit submit to complete registration. If registering more than one family member, make only one payment, and use the same MEMBER ID number for all registrants on seperate registration forms.
Fees: One Child: $50
          Two Child: $75
          Three or more (family) $100

Please proceed to payment link below. Copy and paste into a new window.

https://www.eservicepayments.com/cgi-bin/Vanco_ver3.vps?appver3=wWsk24ZWJSTZKsGd1RMKlg0BDvsSG3VIWQCPJNNxD8upkiY7JlDavDsozUE7KG0nFx2NSo8LdUKGuGuF396vbUIr_hA7DaCW6h99KiJ2n8MiYnTg5dP4O6rpX5QvPEWlBhHDN59kLZFffwKfYERpQnDKCOqcqd-AUo25YVCOzDQ=&ver=3
Egiving member id # and amount paid *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms