Saint Rose of Lima

Northborough, MA

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Life Teen

High School - Grades 9-12
- Registration
  
  The maximum number of form submissions has been reached. This form is currently not available.
  
  Family Name REQUIRED Please fill out this field. Please enter valid data.
  
  Main Family Email REQUIRED Please fill out this field. Please enter an email address.
  
  Mother's Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Mother's Cell Phone Number Maximum 20 characters Please enter a phone number.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Marital Status REQUIRED
  Select One
  Please fill out this field.
  
  Father's Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Father's Cell Phone Number Maximum 20 characters Please enter a phone number.
  
  Father's Email Please enter an email address.
  
  Father's Address (if different from Mother's) Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Registration Information
  
  With Whom Does the Child/Children Live? REQUIRED
  Select One
  Please fill out this field.
  
  If you checked "Other" above, please list the guardian and their relationship to the child Please enter valid data.
  
  Emergency Contact Information
  
  Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Number of Children to be Registered for Life Teen? REQUIRED Please fill out this field.
  
  Child 1
  
  Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Grade in School REQUIRED Please fill out this field. Please enter valid data.
  
  School Attending in 2025-2026 REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Please fill out this field.
  
  Please indicate any specific medical, academic, or behavioral needs of which we should be aware (allergies, IEP, etc...)
  
  Child 2
  
  Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Grade in School REQUIRED Please fill out this field. Please enter valid data.
  
  School Attending in 2025-2026 REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Please fill out this field.
  
  Please indicate any specific medical, academic, or behavioral needs of which we should be aware (allergies, IEP, etc...)
  
  Child 3
  
  Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Grade in School REQUIRED Please fill out this field. Please enter valid data.
  
  School Attending in 2025-2026 REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Please fill out this field.
  
  Please indicate any specific medical, academic, or behavioral needs of which we should be aware (allergies, IEP, etc...)
  
  Child 4
  
  Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Grade in School REQUIRED Please fill out this field. Please enter valid data.
  
  School Attending in 2025-2026 REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Please fill out this field.
  
  Please indicate any specific medical, academic, or behavioral needs of which we should be aware (allergies, IEP, etc...)
  
  Child 5
  
  Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Grade in School REQUIRED Please fill out this field. Please enter valid data.
  
  School Attending in 2025-2026 REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Please fill out this field.
  
  Please indicate any specific medical, academic, or behavioral needs of which we should be aware (allergies, IEP, etc...)
  
  A photograph or video of your child(ren) participating in an event may be used on our website, social media, or in a newspaper story. REQUIRED Please fill out this field.
  
  Volunteers Needed!
  
  Please consider how you can be a part of Life Teen.
  
  Please check areas of interest. Confirmation (Purpose) Teacher Life Teen Life Guard (Dinner Help) Life Teen Core Team Member Life Teen Band
  
  Other Gifts/Talents you would like to share with our program: Please enter valid data.
  
  If you would like to make a voluntary donation to support the success of Life Teen, please select an option below.
  
  Donation 25.0 – Thank You! 50.0 – Thank You! 75.0 – Thank You!
  
  Other Donation
  Your donation helps cover the cost of texts, scholarships, & other expenses for those in need.
  $ Please enter a positive decimal.
  
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- Life Teen Mass is every Sunday at 5PM
  
  Life Nights are every other Sunday from 6-8:30 PM - includes dinner.