Lourdes MS Youth Night Signup Form
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Student Name *
Grade in 2019-2020 *
School Student Currently Attends (or put Home school if that applies)? *
Mom's First & Last Name *
Mom's Email *
Mom's Cell # *
Dad's First & Last Name *
Dad's Email *
Dad's Cell # *
Student Cell # (optional...we never contact youth without also including parents on the communication)
Student Email (optional...we never contact youth without also including parents on the communication)
Student allergies, dietary restrictions, or other special concerns? (If none, simply write "none") *
By checking "yes" below, you are affirming that you, as a parent, have full knowledge of your child's intention to participate in middle school youth nights at Lourdes and that they have your full permission to do so.   Checking "yes" counts as parental consent. *
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