High School Discipleship Registration

Will you be using a debit/credit card to pay for your participant’s registration?(Required)

Yes

Not Paying by Credit Card

Please contact Krystal at the Religious Education Office to register in person.

kmontgomery@stjosephricelake.org
715-736-3104
(The submit button below is disabled)

Participant Information

Participant Name(Required)

First Last

Birthdate(Required)

Gender(Required)

Male

Female

Grade level for current school year(Required)

Young Adult

Chaperone

Name of person filling out the form(Required)

First Last

Best Phone #(Required)

Best Email(Required)

Emergency Contact Name (must be different than any above names)(Required)

First Last

Emergency Contact Best Phone #(Required)

Image and Release Form for Participant

The Diocese of Superior and its affiliated parishes and schools may wish to use an image and/or recording of your child in print and electronic publicity and virtual education. It is the practice of the Diocese of Superior to protect all children at all times including the public use of their image and/or recording. This document has been developed to inform parents and guardians of their right to grant or refuse permission for their child's image and/or likeness to be used in Diocesan and affiliated parish and school media, promotional materials, and virtual education.

Permission to use any video recording, photograph, slide, audio recording, or any other visual or audio reproduction in which your child may appear may include promotional and educational activities such as, but not limited to, websites, social media sites, newsprint, flyers or brochures, virtual classroom. We reserve the right to determine which image and/or recording is used and how long it will remain on the site or is used in media materials.

Parent/Guardian do you give permission?(Required)

YES, I give permission to the Diocese of Superior and affiliated parishes and schools to use the participant’s image and/or recording for above-said use.

NO, I do not give permission to the Diocese of Superior and affiliated parishes to use the participant’s image and/or recording for above-said use.

N/A as I am attending as a Young Adult/Chaperone

Signature of person filling out this form

Please type Signature Name here(Required)

Today's date(Required)

Checkout / Payment

High School Discipleship Weekend Registration fee(Required)

Price:

HSDW reg fee

$0.00

Credit Card(Required)

Card Details

Cardholder Name

High School Discipleship Weekend pre-registration

Not Paying by Credit Card

Participant Information

Image and Release Form for Participant

Checkout / Payment

PARISH ADMINISTRATION OFFICE

Address / Phone:

Email:

Hours: