St. George/St. Jude Youth Group

Name of Participant REQUIRED Please fill out this field. Please enter valid data.

Participant Email Please enter an email address.

Participant Phone Number Please enter a phone number.

Mother Name ( Guardian Name) REQUIRED Please fill out this field. Please enter valid data.

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

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

Father Name (Guardian Name) REQUIRED Please fill out this field. Please enter valid data.

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

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

Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Do you give premission for your child to receive youth group or Confirmation related emails or Texts REQUIRED YES NO Please fill out this field.

Where were you baptized ( For Confirmation Candidates) REQUIRED St. George Catholic Church St. Jude Catholic Church Other Please fill out this field.

Where did you receive your First Communion? ( For Confirmation Candidates REQUIRED St. George Catholic Church St. Jude Catholic Church Other Please fill out this field.

Emergency Contact Name: REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Phone Number REQUIRED Please fill out this field. Please enter valid data.

Are you in general good health and able to participate in normal activities REQUIRED Yes No Please fill out this field.

If No, describe your limitation.

identify any over-the-counter medications you will be bringing to the event

Physician's Name REQUIRED Please fill out this field. Please enter valid data.

Physician's Phone Number REQUIRED Please fill out this field. Please enter valid data.

Participant's Health Insurance Provider REQUIRED Please fill out this field. Please enter valid data.

Policy or Group Number REQUIRED Please fill out this field. Please enter valid data.

Primary Policyholder's Name REQUIRED Please fill out this field. Please enter valid data.

Identify any prescription medications the participant is taking and in what dosage and frequency:

Identify any Dietary restrictions Allergies

St. George Catholic Church
716 South Third Street
Odessa, Mo 64076

St. George/St. Jude Youth Group

Youth Group Schedule 2024/2025-
TBA

Permission Forms for Youth Group