St. Rocco Youth Group Application

ST. ROCCO YOUTH GROUP APPLICATION Name: _______________________ _______________________ ____ Last First MI Address: __________________ __________________________ ________ Street address City Zip code Home phone: ( ) _________________Cell phone :( ) _____________ Email address: ________________________________________ Grade 2009-2010: ______ School: ________________________________ Birthday: _____ / _____ / _____ Parent/Guardian Information Name: _______________________________ ___________________ _____ Last First MI Address: __________________ ___________________________ ________ Street address City Zip code Home phone: ( ) __________________Cell phone :( ) _____________ Please list any interests: ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ What do you hope to get out of the St. Rocco Youth Group? ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ How would you like to help? ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ Please list any additional clubs you are involved with ______________________________________________________________ ______________________________________________________________

Parental Consent Form (please fill one or both) Parent/Guardian 1 Parent/Guardian 2 or another Name: emergency contact Name: _____________________________

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Daytime: ( ) _________________ Evening: ( ) _________________ Cell: ( ) _________________

Daytime: ( ) __________________ Evening: ( ) __________________ Cell: ( ) __________________