God Unplugged Registration

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Student Cell Phone Number Please enter a phone number.

Student Email Please enter an email address.

Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade College Young Adult

I sing and/or ring bells. YES NO

I play an instrument. YES NO

My instrument is Please enter valid data.

Parent/Guardian 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.

Email REQUIRED Please fill out this field. Please enter an email address.

Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Home or Work Phone Number (Optional) Please enter a phone number.

Street Address Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

2nd Parent/Guardian Information:

First Name Please enter valid data.

Last Name Please enter valid data.

Email Please enter an email address.

Cell Phone Number Please enter a phone number.

Allergies or Relevent Health Issues:

I accept having group photographs and livestream or concert video taken of me, my son or daughter for use within the parish, including the bulletin, parish website, Instagram, and parish Facebook page. I accept I do not accept

St. Patrick Parish

41 Oliver St. Chatham, NJ

God Unplugged Registration