Rise/Encounter Registration

The Encounter (Thursdays from 6:30 - 8pm) is for youth in grades 5 & 6.

The Rise (Thursdays from 7-9pm) is for youth in grades 7-12.

To register for either program, fill out the form below.

Youth Information
Youth Name *
Youth Name
The Encounter (Thursdays from 6:30-8pm) is for youth in grades 5 & 6. The Rise (Thursdays from 7-9pm) is for youth in grades 7-12.
Birthday *
Birthday
Youth Phone Number
Youth Phone Number
Communication Consent *
Has this youth been confirmed? (Not required to attend The Encounter or The Rise). *
Has youth attended Steubenville Atlantic Youth Conference before? *
Parent/Guardian Information
Parent/Guardian Name *
Parent/Guardian Name
Parent/Guardian Cell Phone
Parent/Guardian Cell Phone
Parent/Guardian Home Phone
Parent/Guardian Home Phone
Preferred Method of Communication: *
Is your family a registered member of Saint Benedict Parish? (Not required to attend The Encounter or The Rise).
Emergency Contact (if parent/guardian listed is unreachable)
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone Number *
Emergency Contact Phone Number
Permissions
Publicity *
On occasion, Saint Benedict Parish and associated youth ministries take photographs or make an audio or video recording of students and/or adults involved in church/youth activities. I consent to the use of any such photo, audio or video record of the youth named above to be used, distributed or displayed, as agents of the church see fit.
Activities *