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Awaken Registration Form

- Awaken gathers on the First Friday of each month
  
  Awaken Youth Ministry Registration Form
  
  Awaken Youth Ministry is an opportunity for children in grades 6th – 8th to socialize, build fellowship and learn a little about our faith. Our sessions include a different theme and various activities each month. Registration is only required once a year.
- The maximum number of form submissions has been reached. This form is currently not available.
  
  Child's Name
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Home Address
  
  Street Address Please enter valid data.
  
  Address Line 2 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.
  
  Child's Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Child's Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Level REQUIRED Please fill out this field.
  
  Mother's Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Father's Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Primary Email REQUIRED Please fill out this field. Please enter an email address.
  
  Emergency Contact
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Allergies, Medical Conditions, or Special Needs:
  
  Media Release:
  
  I give my consent to utilize any photographs or images of myself, as well as the sound of my voice from any audio or video, to be used by the Diocese of St. Petersburg, or any parishes, schools or entities within the Diocese of St. Petersburg. Such use is given liberally, for any form of media publication, including any form of social media. I waive any rights I might have to inspect and approve the finished product or its use, and further waive any claim for any compensation associated with said use. I acknowledge that I am of legal age and have the full capacity to execute this consent; or, if a minor, I am signing as the legal guardian on behalf of the above individual.
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Awaken Registration Form

Awaken Youth Ministry Registration Form