Steubenville Registration 2025 | Prince of Peace Catholic Community

Address

City/Town

State/Province

ZIP/Postal Code

Parish

In the Fall of 2025, I will be a...

Freshman

Sophomore

Junior

Senior

High School

T-Shirt Size (adult)

Small

Medium

Large

X-Large

2X-Large

3X-Large

Is this participant in general good health and able to participate in general activities?

Yes

No

Name of family physician or clinic:

Family Physician or Clinic Phone #:

If the participant is presently taking any medications, please list them and provide directions for frequency and dosage:

If the participant will be bringing any over the counter medications, please list them:

Are all immunizations up to date:

Yes

No

Please list any special dietary needs, if any:

Please list any operations or serious injuries, including date:

Please list and describe any physical limitations or needs that we need to be aware of:

Parent/Guardian Signature

Payment Method

I will pay today by debit/credit card

I will bring a check/cash to the Parish Office