Youth Ministry

Household Information

Street 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.
Parent 1/Contact 1
First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Parent 1/Contact 1 Relationship to Child REQUIRED Please fill out this field. Please enter valid data.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Email REQUIRED Please fill out this field. Please enter an email address.
Parent 2/Contact 2
First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Parent 2/Contact 2 Relationship to Child REQUIRED Please fill out this field. Please enter valid data.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Email REQUIRED Please fill out this field. Please enter an email address.

Youth Information

Please Read The Following Statement

MEDIA RELEASE STATEMENT:
I hereby authorize the Archdiocese of Dubuque, the host parish(es), and their agents to utilize photographic and/or video images of me or my children. In giving my consent, I hereby indemnify and hold harmless the Archodiocese of Dubuque, the host parish(es), and their agents from any and all responsibility of liability. I understand that I will receive no compensation should any photograph and/or video of my child or me be used.

Media Release Agreement (ONE Response for ALL Youth Registered) REQUIRED I Agree I Do Not Agree Please fill out this field.

Authorizer's Name REQUIRED Please fill out this field. Please enter valid data.

Date REQUIRED Please fill out this field. Please enter a date.

Volunteer Interest? Select "Yes" to be contacted!

Do you have interest in volunteering your time, talent or treasure with Youth Ministry? Select "Yes" and we will reach out to you!

Parents: Please Read

EVERY youth registered must have a current annual liability form on file with Epiphany Parish. You will find the 2024-25 form linked on this page, above the online registration form. If you are unable to print the form, stop into the Parish Office and we can assist.

Confirmation of Registration REQUIRED Please fill out this field. Please enter an email address.

Youth Ministry

Contact Us

Youth Ministry at Epiphany

Youth Ministry Upcoming Events

Documents

2024-25 Youth Ministry Registration