First Name Last Name Email Address Phone Number Street/PO Address City State Postal/Zip Code Teen's email address Birthdate (MM/DD/YYYY) School Attending Grade Mother's Name Mother's Cell Phone Father's Name Father's Cell Phone Parent's Are: MarriedDivorcedSeparatedSingleWidowed Teen Lives With In Case of Emergency, Please Notify (Name) Emergency Contact Phone 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 I give permission for my child(ren) to attend this program I do not give permission for my child(ren) to attend this program, but as the primary educator of my child, I certify that I will provide such training to my child within the family. I will review the materials on the website and notify you later if my child has permission.. 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) SmallMediumLargeExtra Large 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. 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.