MSM Registration Form

STUDENT 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.

Grade REQUIRED 7th Grade 8th Grade Please fill out this field.

Attending: REQUIRED Catholic School Public School Homeschool: Dedicated 7th/8th Grade Curriculum Taught at Home Please fill out this field.

Name of School REQUIRED Please fill out this field. Please enter valid data.

Gender REQUIRED Please fill out this field.

Hobbies and Interests?

List things you enjoy doing in your time away from school?

Please enter valid data.

How would your friends describe you?

Shy, outgoing, energetic, chilled, organized, studious, athletic, etc.

Please enter valid data.

Small Group Requests

Other students/friends you would enjoy being in a small group with.

Please enter valid data.

Important General Information

Use this section to include anything that you feel is important we should know but haven't asked. (i.e. "Do not place me with... in a small group", etc)

Please enter valid data.

Allergies REQUIRED

List NONE if not applicable.

Please fill out this field. Please enter valid data.

Special Needs/Special Adaptive Needs

List any special needs or adaptations you face. This information will only be used to help you succeed.

Please enter valid data.

FAMILY INFORMATION

Is your family registered at St. Vincent de Paul Catholic Church? REQUIRED Please fill out this field.

If NO, where is your family registered? Please enter valid data.

What name is the family registered under? REQUIRED Please fill out this field. Please enter valid data.

Are you a new family to our Middle School Ministry? REQUIRED Please fill out this field.

PROGRAM REGISTRATION (check all that apply): REQUIRED

MSM events include Edge Social/Catechesis Nights and Confirmation Prep includes all required events to prepare for Confirmation

Edge Events only: Any family enrolled in Catholic School or dedicated homeschool REfuel Confirmation Prep: Any family NOT enrolled in a Catholic School or dedicated homeschool Homeschool: Dedicated Homeschool Family Please fill out this field.

PARENT INFORMATION

Mother's First/Last Name REQUIRED Please fill out this field. Please enter valid data.

Mom's Cell REQUIRED Please fill out this field. Please enter a phone number.

Father's First/Last Name REQUIRED Please fill out this field. Please enter valid data.

Dad's Cell Please enter a phone number.

Preferred Contact Person REQUIRED Please fill out this field.

Email: Important Communication Will Be Sent Here REQUIRED Please fill out this field. Please enter an email address.

Student Lives With: REQUIRED Please fill out this field.

Street Address Where Student Resides 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.

EMERGENCY INFORMATION

Emergency Contact First/Last Name REQUIRED

Incase of an emergency, who can we contact other than parents/guardian?

Please fill out this field. Please enter valid data.

Emergency Contact Primary Phone # REQUIRED Please fill out this field. Please enter a phone number.

FAMILY CONSENT FORMS

Photo Permission, Electronic Communication, Over-the-counter medication. To verify consent, a code will be given to you at a later date along with a form to enter your code into to verify consent. Please be sure to sign this and promptly return it.

PHOTO PERMISSION: I give permission for photos, videos and/or other media of my child for any lawful purpose, including but not limited to such purposes as publicity, illustration, advertising, Web content and social media platforms.

PHOTO PERMISSION REQUIRED I Agree I Disagree Please fill out this field.

ELECTRONIC COMMUNICATION:
Middle School Ministry will use several different formats of communication with our families during the school year. We will communicate directly to parent/adult guardians according to the Diocesan Safe Environment Policy. The following is an example of the electronic formats we may use during the year:
● Flocknote (Emails and Texts)
● Parish/organization website saintv.org
● Emailing from a St. Vincent governed email: @saintv.org (Google)
● Online video streaming (Zoom, Google Classroom, etc)
● Phone Calls (limited to respect your busy lifestyle)
● Educationally appropriate websites or applications as chosen by the Chaplain of Youth Ministries and Director of the Middle School Ministry (Bishop Barron’s Word on Fire ENGAGE, Fr. Mike Schmitz YouTube/Spotify blog, etc.)

By clicking below, you willingly agree to review communication from our ministry group on a regular basis and respond accordingly within described deadlines. You show that you understand that updated information is vital to your child's successful participation in their middle school ministry community. Lastly, you agree to allow us to communicate directly to you, the responsible party of the named student above.

I Agree Please select this field.

CARPOOL LIST :
I give permission to share my name, phone number, email address and neighborhood name on a Middle School Ministry document. I understand this information will be used for other families to contact me in regards to setting up carpool options. I do not hold the Diocese of Fort Wayne-South Bend, St. Vincent de Paul Church Staff, and/or St. Vincent de Paul Middle School Ministry Director responsible for coordination of rides for family carpool opportunities.

OVER-THE-COUNTER MEDICATION REQUIRED

In the event it is needed, please check one of the following:

No medication of any type, whether prescription or non-prescription, may be administered to my child unless the situation is life-threatening and emergency treatment is required. I hereby grant permission for non-prescription medication (i.e. non-asprin products such as acetaminophen or ibuprofen, throat lozenges, cough syrup) to be given to my child, if deemed appropriate. Please fill out this field.

CARPOOL LIST REQUIRED I Agree I Disagree Please fill out this field.

If AGREE with Carpooling: Neighborhood OR Nearest Landmark near your home. Please enter valid data.

VOLUNTEER OPPORTUNITIES:
We occasionally need adult volunteers to provide support for our events. All adult volunteers will be required to receive Safe Environment Certification which is provided by the church. Please indicate what areas you are interested in receiving additional information about.

Selected all that apply: REQUIRED Adult Core Team Substitute Small Group Leaders Behind-the-Scenes: Serving Snacks, Assisting in Transitions, etc. Retreat: Support Retreat: Table Leader Retreat: Speaker/Witness Not interested at this time. Please fill out this field.

Is there any additional information you think we should know regarding your student and his/her attendance at Middle School Ministry Events?

PARENT/GUARDIAN SIGNATURE

By typing my name, I agree that this can be used as a legal signature. My signature acknowledges that I have read and that I understand the information provided within this registration form.

Typed Signature Below REQUIRED Please fill out this field. Please enter valid data.