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Digital Medical Form 2024-25
The Diocese of Lansing, and St. Rita Parish, require a health history and medical release form for participation in all parish programs and activities. Completion of this form fulfills the above requirement for all EDGE and Lifeteen participants for the 2024-2025 school year.
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* Indicates required question
Child's name:
*
Your answer
Child's sex:
*
Male
Female
Child's birthday:
*
MM
/
DD
/
YYYY
Child's current age:
*
Your answer
Parent/guardian name:
*
Your answer
Parent/guardian relationship to participant:
*
Your answer
Street Address:
*
Your answer
Primary phone number:
*
Your answer
Secondary phone number:
Your answer
Student's grade for the current academic year:
*
Your answer
My child will be attending:
*
Religious Education (K-5, 10:00 - 11:00 a.m. on Sundays
EDGE (6-8 grade, 10:00 - 11:00 a.m. on Sundays)
Lifeteen (9-12 grade, 6:00 - 7:30 p.m. on Sundays)
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