2022-2023 St. John Vianney Catholic Church High School Ministry

YDisciple is open to all teenagers in Grades 9-12.

Family Information

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.

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.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

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.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Emergency Contact

In the event it comes to the attention of the YDISCIPLE Team that your child becomes ill with symptoms such as headache, vomiting, sore throat, fever, diarrhea, you will be called. If we are unable to contact you, the emergency contact person listed below will be contacted.

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Relationship to Child REQUIRED Please fill out this field. Please enter valid data.

Media and SJV Web Page Release

We believe that both the youth and the Parish benefit from positive recognition. There may be occasions for media coverage including your student throughout the year, through shared video or pictures.

***No names will be used***

This could include, but not be limited to:
Public Media: Newspaper, TV, Catholic Moment, other public media
Church Media: Bulletin Boards, Parish Videos, Newsletters, other church media
Web Based Media: Parish Web site, Other related ministry and religious web sites, social meda
By checking the box "I agree", below you are indicating your permission and consent.

I Agree Please select this field.

Student Information

Number of Children You Are Registering REQUIRED Please fill out this field.
Child 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.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Birthdate: REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Please fill out this field.
- Please select which Sacraments this child has received: REQUIRED Baptism First Reconciliation First Holy Communion Confirmation Please fill out this field.
- Please provide any additional information that would be helpful for us to know about your student. This will be kept confidential within YDisciple leadership.
Child 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.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Birthdate: REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Please fill out this field.
- Please select which Sacraments this child has received: REQUIRED Baptism First Reconciliation First Holy Communion Confirmation Please fill out this field.
- Please provide any additional information that would be helpful for us to know about your student. This will be kept confidential within YDisciple leadership.
Child 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name 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.
- Birthdate: REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Please fill out this field.
- Please select which Sacraments this child has received: REQUIRED Baptism First Reconciliation First Holy Communion Confirmation Please fill out this field.
- Please provide any additional information that would be helpful for us to know about your student. This will be kept confidential within YDisciple leadership.
Child 4
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name 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.
- Birthdate: REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Please fill out this field.
- Please select which Sacraments this child has received: REQUIRED Baptism First Reconciliation First Holy Communion Confirmation Please fill out this field.
- Please provide any additional information that would be helpful for us to know about your student. This will be kept confidential within YDisciple leadership.
Child 5
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name 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.
- Birthdate: REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Please fill out this field.
- Please select which Sacraments this child has received: REQUIRED Baptism First Reconciliation First Holy Communion Confirmation Please fill out this field.
- Please provide any additional information that would be helpful for us to know about your student. This will be kept confidential within YDisciple leadership.
Child 6
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name 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.
- Birthdate: REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Please fill out this field.
- Please select which Sacraments this child has received: REQUIRED Baptism First Reconciliation First Holy Communion Confirmation Please fill out this field.
- Please provide any additional information that would be helpful for us to know about your student. This will be kept confidential within YDisciple leadership.
Child 7
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name 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.
- Birthdate: REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Please fill out this field.
- Please select which Sacraments this child has received: REQUIRED Baptism First Reconciliation First Holy Communion Confirmation Please fill out this field.
- Please provide any additional information that would be helpful for us to know about your student. This will be kept confidential within YDisciple leadership.
Child 8
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name 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.
- Birthdate: REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Please fill out this field.
- Please select which Sacraments this child has received: REQUIRED Baptism First Reconciliation First Holy Communion Confirmation Please fill out this field.
- Please provide any additional information that would be helpful for us to know about your student. This will be kept confidential within YDisciple leadership.

Safe Environment Committment

The Diocese of Lafayette-in-Indiana, as well as St. John Vianney Catholic Church, is committed to protecting our young people. We require all staff and adult volunteers to have a current background check on file, and to be certified in our diocesan provided, and mandated, Safe and Sacred Training program. Please contact the parish office at 485-0150, for more details on how to receive the training, or check to see if yours is still current (valid for three years).

How would you like to volunteer? Mentor for Small Groups (training provided) ADOREUMUS Nights Youth Retreat Committee Outreach Day Committee

St. John Vianney
Catholic Church, Fishers, IN

A Pastorate of the Diocese of Lafayette-in-Indiana

YDisciple Online Registration Form

2022-2023 St. John Vianney Catholic Church High School Ministry

Family Information

Father's Information:

Mother's Information:

Emergency Contact

Media and SJV Web Page Release

Student Information

Safe Environment Committment

ST. JOHN VIANNEY CATHOLIC CHURCH