St. Monica Youth Ministry - Grades 6 – 12

St. Monica Catholic Community
4140 Walnut Hill, Dallas Texas 75229
Tel: 214-357-8549 x135 Fax: 214-357-7802
Michelle Tomlinson – Youth Director – Email: mtomlinson@stmonicachurch.org

The Registration process is the following:
   1. Fill out this form.
   2. When the form is complete, the release sheets will be displayed.
   3. Print these, sign them, and include them with your payment.
   4. If you do not have a printer, you can sign the release forms at the office.
Thank you for keeping your teen(s) involved in the youth ministry program at St. Monica Church.

Family Last Name *     Home Phone *

Address *     City *     ZIP *

 First NameWork PhoneCell PhoneE-mail Address
Dad
Mom

Note: E-MAIL ADDRESSES ARE VERY IMPORTANT. THIS IS OUR PRIMARY FORM OF COMMUNICATIONS.
Please notify us if e-mail addresses change.

Name of TeenDOB
mm/dd/yyyy		SchoolGrade 09-10 Sacraments ReceivedActive in
RE 08-09?		Cell PhoneE-mail Address T-shirt Size
Baptism
Reconcialition
Eucharist
Confirmation		 Yes
No
Baptism
Reconcialition
Eucharist
Confirmation		 Yes
No
Baptism
Reconcialition
Eucharist
Confirmation		 Yes
No

Teen 1 Allergies - Teen 1

Other Information that we should know about your teen’s health or physical condition


Doctor’s Name     Name of Insurance Company     Policy Number

Teen 2 Allergies - Teen 2

Other Information that we should know about your teen’s health or physical condition


Leave the following fields blank if the information is the same as Teen 1
Doctor’s Name     Name of Insurance Company     Policy Number

Teen 3 Allergies - Teen 3

Other Information that we should know about your teen’s health or physical condition


Leave the following fields blank if the information is the same as Teen 1
Doctor’s Name     Name of Insurance Company     Policy Number

Emergency Contact Person(s) and Tel # (at least one)
NamePhone

Please consider a call to minister with our young people. Below are some areas for you to consider. Training will be provided.

Middle School CatechistRetreatsSubstitute Catechist
High School Adult LeaderService OpportunitiesOffice Aide
Special EventsRefreshments

All Adults who work with youth must comply with the Safe Environment Program mandated by the Diocese of Dallas.

REGISTRATION FEES: One Student $65 Two Students $75 Three or more $85

Make check or money order payable to “St. Monica Youth Program”
Please write “St. Monica Youth” in the comment area.