First Name Last Name Email Address Phone Number (formatted with dashes: 123-456-7890) Street/PO Address City State Zip (5 digits) Teen's email address Birthdate (MM/DD/YYYY) School Attending Grade 9101112 Mother's Name Mother's Cell Phone (formatted with dashes: 123-456-7890) Father's Name Father's Cell Phone (formatted with dashes: 123-456-7890) Parent's Are: MarriedDivorcedSeparatedSingleWidowed Member Lives With Both parentsMomDadOther In Case of Emergency, Please Notify (Name) Emergency Contact Phone (formatted with dashes: 123-456-7890) ] VIRTUS Safe Environment Training As mandated by the Archdiocese of Atlanta, STM will present the VIRTUS sexual abuse prevention program to our students every year. As a parent, you have the right to choose whether your student participates in the program. We encourage you to learn more here. VIRTUS Safe Environment Training Do you give permission for your child to participate in our yearly safe environment training that occurs every October? Yes No Medical Emergency Waiver In the event of an emergency, I give permission to transport my child to a hospital for medical attention. I wish to be advised prior to any further treatment. If you are unable to reach me, use the emergency contact listed above. Yes No Media Waiver I authorize my child to be included in publications, websites, or instructional activities, for STM or the Archdiocese of Atlanta, through photographs, videos, artwork, written work, or statements, in this or subsequent years. Yes No T-shirt Size (Adult sizes) SMLXL After registering, please submit your payment via STM Online Giving. Click Online Giving at the top of the page, log in, choose Give a New Gift and then choose Lifeteen Registration to complete the process. A 'quick give' is NOT accepted for payment of registration fees. Please make sure to fill out the medical release & the annual permission slip. Your registration won't be able to be completed until ALL these forms are turned in. I understand my child won't be fully registered until I submit the payment, medical release form and permission slip.