Register Here for Life Teen Life Teen Registration Name of Teen* First Last Date of Birth (xx/xx/xxxx)* Name of High School you will attend in 2023-2024*Blessed TrinityChamblee HSDunwoody HSMaristNorth Springs HSRiverwood HSSt. Pius XOtherPlease list school here* Grade Level*9th10th11th12thStudent Cell*Student Email* Does child have special needs we should know about?*NoYesIf Yes to above, please comment here*Parent Name* First Last Parent Email* Parent Phone*2nd Parent Name First Last 2nd Parent Email 2nd Parent PhoneHome Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are you a registered parishioner with Saint Jude?*YesNoPlease list your parish of registration* Emergency Contact Name* First Last Emergency Contact Phone*Media Release*Saint Jude uses images, interviews, and videos of our children for a variety of internal and external communications. Our forms of internal and external communications include but are not limited to: print, such as newspapers, bulletins, and newsletters; photographs and digital images; film and videos; web posts, web pages, and image carousels. I hereby grant permission for Saint Jude the Apostle to use images and interviews of my child for internal or external communications for one year. My child may be photographed and/or interviewed for The Georgia Bulletin, and other media outlets. I understand content may be reprinted in The Georgia Bulletin or other media for public dissemination, including but not limited to film; video; television; radio; newspapers such as The Atlanta Journal and Constitution; websites. I release and relieve Saint Jude the Apostle and the Archdiocese of Atlanta from any responsibility or liability for any claims arising from the publication or reproduction of any photographs or interview in any news or other media. I waive any and all right to inspect or approve the finished images, video, or printed matter that may be used in conjunction with any image or video, or to approve the eventual use for which it may be applied. I understand that photographs, videos, and/or interviews are being done with the knowledge and approval of Saint Jude the Apostle and that a signed release form is required for every participating individual. I agree to the media policyMedical ReleaseI understand that reasonable precautions will be taken to safeguard the health and well-being of the participants in our Life Teen program, and that I will be notified as soon as possible in the event of any emergency. In the case of sickness or an accident, I authorize and give consent to the Life Teen team, or other associated volunteers of the Life Teen program, to obtain medical care from a licensed physician, hospital, or medical clinic for my son /daughter in the event that myself or other legal guardian(s) cannot be reached. I hereby do release and forever discharge the Archdiocese of Atlanta and Saint Jude the Apostle Catholic Church from all manners of actions or claims, which I or my child(ren) shall or may have for any reason, arising from my child's attendance in the Life Teen program at Saint Jude the Apostle Catholic Church. I agree to the medical policy.Permission to Contact Youth*Saint Jude the Apostle Catholic Church follows the Archdiocese of Atlanta’s Social Media Policy and Guidelines for the Use of Social Networking Sites with Minors for contacting youth via social media. We may also use text messages, email, and parish-approved online/virtual platforms to contact youth. Per this policy and guidelines, parents must be made aware of how social media and electronic communications are being used. Parents must be told how to access the sites and be given the opportunity to be copied on all material sent to their children. After receiving written permission to communicate with young people, Archdiocesan employees should be encouraged to save copies of conversations whenever possible, especially those that concern the personal sharing of a teen or young adult. Please reference the policy and guidelines for more information. I hereby grant permission for Saint Jude the Apostle Catholic Church to contact my child for internal or external communications for one year via social media, email, text, and/or parish-approved online/virtual platforms. I understand I can request the same communications provided to my child, and that it does not have to be via the same technology (for example, if children receive a reminder via Twitter, parents can receive it in a printed form or by an email list). I give permission I do not give permission Archdiocesan VIRTUS attendance*The Archdiocese of Atlanta subscribes to VIRTUS® to provide a consistent Safe Environment foundation for our children. It is the shared responsibility of parents, teachers, and catechists to give our children the awareness and tools they need to overcome anyone who intends to harm them. It is an expectation that all Catholic Schools and Faith Formation programs use the VIRTUS® Lesson plan. I give my permission for my child(ren) to attend the Archdiocesan VIRTUS Program. I give permission I do not give permission Payment Options Pay by credit card (click submit and you will be directed to our payment page) Check or cash (click submit but do not pay. Bring cash/check to parish office Contact me about a payment plan or scholarship (click submit and do not pay) My teen is enrolled in the Confirmation program (click submit but do not pay) PaymentAfter clicking SUBMIT, you will be redirected to our payment page. Please click Submit ONLY once. Thank you!