Seedbearers Teen Form 2026

Seedbearers Teen Form 2026
TEEN INFORMATION:
Teen Name:

First NameLast Name
Grade (2026-27 school year)
Name of High School
T Shirt Size
Teen Email Address
Family members attending Thursday Family night dinner (after 5pm mass)
PARENT INFORMATION
Parent/Guardian Name

First NameLast Name
Relationship to Teen
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Emergency Contact (if different from Parent/Guardian)
MEDICAL INFORMATION
Physician Name
Physician Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Insurance Provider
Upload an image of your teen's insurance card (required for overnight retreats in case of emergency)

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Medical Concerns or medications taken (if none, put N/A)
General Allergies (if none, put N/A)
Food Allergies?
Describe any Food Allergies:
If your teen has food allergies, PLEASE upload a photo of them so that our kitchen staff can identify that person!

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Consent,Certification, & Media Release
I hereby grant consent for my child, _______to participate in Seedbearers 2026 with IMPACT Youth Ministry. I understand that this event will take place away from the St. Elizabeth Ann Seton church/youth grounds and that my child will be under the supervision of the designated parish employee and other adult volunteers.
Parent Signature of Agreement with the above statements.
Signature Date

MonthDayYear
Date
Guardian Angel Information

(This is kind of like a Secret Santa gift exchange that goes on throughout the week! Please fill in this information for your teen!)
Favorite Candy
Favorite Color
Favorite Sport/Team
Favorite TV/Movie/Book
Favorite Restaurant
Things you collect
What are some of your hobbies?
Favorite music/band
Favorite/patron Saint?
What other interests do you have?

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Seedbearers Initial Registration Fee

Each Teen pays $200 to register, and is supposed to each fundraise an additional $200 before the week of Seedbearers! Fundraised cash/checks can be turned in to Danielle Farley or the parish office!

$200.00 Quantity

Seedbearers Initial Registration Fee (PLUS additional $200 of Fundraised Money)

Select this option if you would like to pay BOTH the inital registration fee AND the additional $200 of fundraised money. The expectation is that your teen will still fundraise, and you will just reimburse yourself.

$400.00 Quantity

Seedbearers - I will send in cash or check to the parish office/Danielle

Please write all checks to "St. Elizabeth Ann Seton" and put "Seedbearers" in the memo line!

Free Quantity

Total

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Seedbearers Teen Form 2026

TEEN INFORMATION:

PARENT INFORMATION

MEDICAL INFORMATION

Consent,Certification, & Media Release

Guardian Angel Information

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