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Teen Night Registration

Please register for Teen Night so we know how many teens to expect.  Invite your friends from the community to join as well.  They do not need to be a member of our Parish.

Parent Information
Name
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Phone --
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E-mail
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Child 1
Child's Name
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Child's Phone --
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Grade in Fall 2022
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Child 2
Child's Name
  •  
Child's Phone --
  •  
Grade in Fall 2022
  •  
Child 3
Child's Name
  •  
Child's Phone --
  •  
Grade in Fall 2022
  •  
Child 4
Child's Name
  •  
Grade in Fall 2022
  •  
Child's Phone --
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Planners Needed
If you or your child(ren) are interested in helping to plan this event, please add contact information below. We will reach out to you sometime in July.
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Photo Policy
Photos may be taken of students attending Teen Night at the Crossings Center to be posted on the St. Rose of Lima website and bulletin boards. Photos that appear online will not identify any student by name.
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Additional Details
Special Needs/Medication
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Please list child's name & needs. Send procedure plan to parish office if needed.
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Parent Signature
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Once you submit this form, the confirmation page will have information to help you calculate your tuition and make an online payment.