Pastoral Juvenil Date/Fecha MM slash DD slash YYYY Student Name/Nombre del estudiante(Required) First Last Address/dirección(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Grade/Grado(Required) School Attending/Escuela(Required) Phone/Número de teléfono(Required)Email(Required) Birthdate/Nacimiento MM slash DD slash YYYY T-shirt Size Parent Name/Nombre de los padres(Required) First Last Primary Phone/Número de teléfono de los padres(Required)Email Mother's Cell PhoneFather's Cell PhoneEmergency Contact(Required) First Last Emergency Contact Phone(Required)Parents are/Los padres son Married Separated Divorced Single Please list any special needs and/or allergies that would assist us in planning for your family's participation/Por favor, enumere cualquier necesidad especial y / o alergia que nos ayudaría a planificar la participación de su familia: Sin títuloPlease indicate if your child has received the following sacraments/Por favor, indique si su hijo ha recibido los siguientes sacramentos Baptism First Reconciliaton First Communion Parents - would you like to: (please check all that apply) Provide snacks Chaperone an event Provide transportation Provide prayer support Host a small group study May the Sacred Heart Youth Ministry team contact your child directly via phone, text or email/¿Puede el equipo del Ministerio Juvenil del Sagrado Corazón comunicarse con su hijo directamente por teléfono, mensaje de texto o correo electrónico?(Required) Yes No Photo Release: I give permission for Sacred Heart Cathedral to take photos or video of my child during Antioch and Antioch-related activities to use in SHC sponsored media (i.e. bulletin, videos, newsletters, parish Facebook, SHC website, etc.)/Autorización de la foto: Doy permiso para que la Catedral del Sagrado Corazón tome fotos o videos de mi hijo durante Antioquía y actividades relacionadas con Antioquía para usarlas en los medios patrocinados por SHC (es decir, boletines, videos, boletines informativos, Facebook parroquial, sitio web de SHC, etc.).(Required) Yes No Website CommentsThis field is for validation purposes and should be left unchanged.
