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Register here for Youth Group

- Student Information
  
  The maximum number of form submissions has been reached. This form is currently not available.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthday REQUIRED Please fill out this field. Please enter a date.
  
  Graduation Year REQUIRED Please fill out this field.
  
  School REQUIRED Please fill out this field. Please enter valid data.
  
  Home 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.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Safety Information
  
  Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter an email address.
  
  Medical Notes REQUIRED
  Allergies, dietary restrictions, diagnoses, etc.
  Please fill out this field. Please enter valid data.
  
  I understand that by checking the box below, that I give permission for St. Boniface Catholic Church to seek medical treatment for my child and to transport them to a hospital for medical treatment in the event of an emergency. And for St. Boniface staff and volunteers to provide basic first aid treatments to my child.
  I Agree Please select this field.
  
  Photos from youth group activities may be used to promote the youth group and shared with the St. Boniface and Waukee communities; this includes printed format and online usage from parish publications. Youth will not be identified by name. By checking the box below, I indicate permission for my child's photo to be used.
  I Agree Please select this field.
  
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