Online Youth Registration Form

“Blessed are the Merciful”
“Blessed  are the merciful, for they shall obtain mercy”  (Matthew 5:7)



Please complete all the information below to register for the Eucharistic Youth Rally.  You will be directed to a link for Paypal after you complete the form. 

To register more than one child from the same family, please register each child separately.  You may make one lump payment at the end of the registration process.

    • Youth Registrant Name*
    • Street Address*
    • City*
    • State*
    • Zip Code*
    • Home Phone Number*
    • Date of Birth*
    • Male/Female*
    • Registrant Email Address
    • T-Shirt Size*
    • Parent Name(s)*
    • Parent Cell Phone Number
    • Parent Email Address*
    • Is your family a member of Children of Mary Home Schoolers?*
      If "no" please fill in the name of the COMHS Referral Family.
    • COMHS Referral Family
    • Rosary Play Participation*
        Please respond if you are interested in participating in the LIGHT Rosary Musical performed the day of the EYR.
      Please note that there is a mandatory practice on Oct. 30 at 2pm for LIGHT
    • Liability and Medical Release Form*
        IMPORTANT: Each participant (youth & adult) must print & complete a Liability/Medical Release Form (to the right) & mail to: EYR c/o 386 N. Buffalo St, Springville, NY 14141 -or- bring to Rally. No one will be allowed to participate without this form.
      Please select "Printing Complete" after you have printed out the form.
    • Code of Conduct*
        Each youth must read the following and click "I agree."
      I agree to project an image of Christian consideration, sensitivity, and respect to everyone around me through my language, dress, and behavior. I will respect the authority of my chaperones & those in leadership. I will also respect the grounds of QW.
    • NOTES:
  • Security Code*

    (Enter the code above)
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