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PREP and LifeTeen Registration

Registration Information
Please click on Registration Information Package here or to the right to view and or print information, schedules, policies or forms.
The maximum number of form submissions has been reached. This form is currently not available.
- Household Information
  
  Household Mailing Address REQUIRED Maximum 50 characters Please fill out this field. Please enter valid data.
  
  City, State, Zip REQUIRED Maximum 50 characters Please fill out this field. Please enter valid data.
  
  Home Phone Maximum 20 characters Please enter valid data.
  
  Church Parish you are registered in: Maximum 50 characters Please enter valid data.
  
  IF YOU ARE NOT REGITERED IN ANY PARISH, and would like to register at Our Lady Queen of Heaven Church, please click on the Parish Registration link to the right under Documents .
  
  Would you like to help
  
  Fathers Full Name Maximum 50 characters
  First Middle Last
  Please enter valid data.
  
  Cell Phone Maximum 20 characters Please enter valid data.
  
  Cell Carrier
  
  Work Phone Maximum 20 characters Please enter valid data.
  
  Email Maximum 50 characters Please enter an email address.
  
  Mother's Full Name Maximum 50 characters
  First Middle Maiden Last
  Please enter valid data.
  
  Cell Phone Maximum 20 characters Please enter valid data.
  
  Cell Carrier
  
  Work Phone Maximum 20 characters Please enter valid data.
  
  Email Maximum 50 characters Please enter an email address.
  
  Step Parent Full Name Maximum 50 characters
  First Middle Maiden Last
  Please enter valid data.
  
  Cell Phone Maximum 20 characters Please enter valid data.
  
  Cell Carrier Please enter valid data.
  
  Work Phone Maximum 20 characters Please enter valid data.
  
  Email Maximum 50 characters Please enter an email address.
- Student Information 1
  
  Student's Full Name REQUIRED Maximum 50 characters
  First Middle Last
  Please fill out this field. Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Grade Level REQUIRED Please fill out this field.
  
  School Attending Maximum 50 characters Please enter valid data.
  
  Sacraments Needed
  
  List All Special Needs, e.g. physical or medical restrictions, ADD, allergies, asthma, diabetes, autism, vision/hearing impairment, etc.
  
  If moving from another parish, where did student last attend religious education: Maximum 50 characters Please enter valid data.
- Student Information 2
  
  Student's Full Name Maximum 50 characters
  First Middle Last
  Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Grade Level
  
  School Attending Maximum 50 characters Please enter valid data.
  
  Sacraments Needed
  
  List All Special Needs, e.g. physical or medical restrictions, ADD, allergies, asthma, diabetes, autism, vision/hearing impairment, etc.
  
  If moving from another parish, where did student last attend religious education: Maximum 50 characters Please enter valid data.
- Student Information 3
  
  Student's Full Name Maximum 50 characters
  First Middle Last
  Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Grade Level
  
  School Attending Maximum 50 characters Please enter valid data.
  
  Sacraments Needed
  
  List All Special Needs, e.g. physical or medical restrictions, ADD, allergies, asthma, diabetes, autism, vision/hearing impairment, etc.
  
  If moving from another parish, where did student last attend religious education: Maximum 50 characters Please enter valid data.
- Student Information 4
  
  Student's Full Name Maximum 50 characters
  First Middle Last
  Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Grade Level
  
  School Attending Maximum 50 characters Please enter valid data.
  
  Sacraments Needed
  
  List All Special Needs, e.g. physical or medical restrictions, ADD, allergies, asthma, diabetes, autism, vision/hearing impairment, etc.
  
  If moving from another parish, where did student last attend religious education: Maximum 50 characters Please enter valid data.
- Student Information 5
  
  Student's Full Name Maximum 50 characters
  First Middle Last
  Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Grade Level
  
  School Attending Maximum 50 characters Please enter valid data.
  
  Sacraments Needed
  
  List All Special Needs, e.g. physical or medical restrictions, ADD, allergies, asthma, diabetes, autism, vision/hearing impairment, etc.
  
  If moving from another parish, where did student last attend religious education: Maximum 50 characters Please enter valid data.
- Student Information 6
  
  Student's Full Name Maximum 50 characters
  First Middle Last
  Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Grade Level
  
  School Attending Maximum 50 characters Please enter valid data.
  
  Sacraments Needed
  
  List All Special Needs, e.g. physical or medical restrictions, ADD, allergies, asthma, diabetes, autism, vision/hearing impairment, etc.
  
  If moving from another parish, where did student last attend religious education: Maximum 50 characters Please enter valid data.
- Photo/Video Release Form
  
  This is to allow us to take pictures & videos at PREP and LifeTeen and post them on our website, bulletin, or facebook page to capture the great moments at OLQH!)
  
  I hereby give permission for images of my child, captured at Our Lady Queen of Heaven Catholic Church Ministry events through video, photo and digital camera, to be used solely for the purpose of Our Lady Queen of Heaven Catholic Church promotional material and publications, and waive any rights of compensation or ownership thereto. I hereby waiver any right that I or the Minor may have to inspect or approve the finished product or products and the advertising copy or other matter that may be used in connection therewith or the use to which it may be applied.
  
  I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND SIGN IT OF MY OWN FREE WILL FOR ALL STUDENTS NAMED ABOVE
- I, parent/guardian, agree to photo/video release of above listed students - Name of Parent or Guardian REQUIRED Please fill out this field. Please enter valid data.
- Yes/No REQUIRED Yes No Please fill out this field.
- Date REQUIRED Please fill out this field. Please enter a date.
- Online Registration Form with Payment
  To register for PREP or LifeTeen, please complete the following form. Payment must be made to complete registration. Clicking the submit button will bring you to the payment page. Once you have entered your payment information your registration will be submitted to the PREP office. If you are not making payment online, please use the printable registration form available in the Registration Information Package Link above or to the left and return by mail or in person to the PREP office.
- Email (to receive a reply) Please enter an email address.
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PREP and LifeTeen Registration

Registration Information

Online Registration Form with Payment