MSM Registration

In order for your child to participate in the Middle School Ministry program, you MUST register.

Student Information

Student's Name

First Name*

Middle Name

Last Name*

Grade entering in the fall

Required*

Date of Birth

Required* //

Student's Phone Number

Student's E-mail

Any Allergies?

Please list any allergies the student may have.

Family Information

Father's Name

First Name

Middle Name

Last Name

Father's E-mail

Please provide us with the email of one parent.

Father's Phone Number

Mother's Name

First Name

Middle Name

Last Name

Mother's E-mail

Mother's Phone Number

Parish Registration

Is the family registered with St. Albert the Great Parish?

Preferred Contact

	Father
	Mother

Emergency Contact

Contact Name

First Name*

Last Name*

Name of the person to contact.

Relationship

Tell us what the relationship is with the student (e.g. parent, legal guardian, grandparent, friend).

Contact Phone Number

Emergency Instructions

What if any special instructions in the event of an emergency.