Cathedral of St. Francis of assisi

diocese of metuchen

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  Dear Parents,
  
  We are in the process of forming a group to participate in this year's Steubenville event. If your child is at least entering High School, please provide your contact information and that of your child who wants to join us in Springfield MA on July 29-July 31. With the information you provide you will contacted to participate in helping plan this event.
  
  Also, please let us know if you are considering to be one of our Adult chaperones.
  
  Peace,
  
  Fr. Edgar
  
  Parent'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.
  
  Street Name 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.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Primary Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Able to Text on Primary No.? REQUIRED Please fill out this field.
  
  Secondary Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Would you be willing to be a Chaperone? REQUIRED Yes No Please fill out this field.
  
  Name of Participant (#1)
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  High School REQUIRED Please fill out this field.
  
  Sex REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Name of Participant (#2)
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Nickname Please enter valid data.
  
  High School
  
  Date of Birth Please enter a date.
  
  Sex
  
  Name of Participant (#3)
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Nickname Please enter valid data.
  
  High School
  
  Date of Birth Please enter a date.
  
  Sex
  
  Name of Participant (#4)
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Nickname Please enter valid data.
  
  High School
  
  Date of Birth Please enter a date.
  
  Sex
  
  I understand that all information I provided will be saved and may be used for youth ministry events and notifications by the Parish. REQUIRED Agree Please fill out this field.
  
  Parent's Initial REQUIRED Please fill out this field. Please enter valid data.
  
  Submit
  
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