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Angst Home Viewing Registration

- We kindly ask that youths who wish to view the Angst video register with a responsible adult. This form allows the registration of one or more adults and one or more youths who will watch the video together and discuss it at home. Access to the video is available only from 6am September 15 until 11:30pm EDT October 15.
  
  After you click Submit, you will receive a confirmation message by email. The message will include your access link to the video, as well as links to a discussion guide and tips sheet.
  
  If you have any difficulty registering, please contact our webmaster, with Registration Difficulty as the subject.
- The maximum number of form submissions has been reached. This form is currently not available.
  
  Adult who will view and discuss Angst with youth
  
  Responsible adult
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Parish REQUIRED CSG OLS St John Vianney Other Please fill out this field.
  
  Additional group members REQUIRED Please fill out this field.
  
  Group member 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.
  
  Status REQUIRED Adult Youth Please fill out this field.
  
  Youth birthdate
  mm/dd/yyyy
  Please enter a date.
  
  Group member 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.
  
  Status REQUIRED Adult Youth Please fill out this field.
  
  Youth birthdate
  mm/dd/yyyy
  Please enter a date.
  
  Group member 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.
  
  Status REQUIRED Adult Youth Please fill out this field.
  
  Youth birthdate
  mm/dd/yyyy
  Please enter a date.
  
  Group member 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.
  
  Status REQUIRED Adult Youth Please fill out this field.
  
  Youth birthdate
  mm/dd/yyyy
  Please enter a date.
  
  Group member 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.
  
  Status REQUIRED Adult Youth Please fill out this field.
  
  Youth birthdate
  mm/dd/yyyy
  Please enter a date.
  
  Group member 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.
  
  Status REQUIRED Adult Youth Please fill out this field.
  
  Youth birthdate
  mm/dd/yyyy
  Please enter a date.
  
  Group member 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.
  
  Status REQUIRED Adult Youth Please fill out this field.
  
  Youth birthdate
  mm/dd/yyyy
  Please enter a date.
  
  Group member 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.
  
  Status REQUIRED Adult Youth Please fill out this field.
  
  Youth birthdate
  mm/dd/yyyy
  Please enter a date.
  
  Group member 9
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Status REQUIRED Adult Youth Please fill out this field.
  
  Youth birthdate
  mm/dd/yyyy
  Please enter a date.
  
  Group member 10
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Status REQUIRED Adult Youth Please fill out this field.
  
  Youth birthdate
  mm/dd/yyyy
  Please enter a date.
  
  Group member 11
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Status REQUIRED Adult Youth Please fill out this field.
  
  Youth birthdate
  mm/dd/yyyy
  Please enter a date.
  
  Group member 12
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Status REQUIRED Adult Youth Please fill out this field.
  
  Youth birthdate
  mm/dd/yyyy
  Please enter a date.
  
  Group member 13
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Status REQUIRED Adult Youth Please fill out this field.
  
  Youth birthdate
  mm/dd/yyyy
  Please enter a date.
  
  Group member 14
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Status REQUIRED Adult Youth Please fill out this field.
  
  Youth birthdate
  mm/dd/yyyy
  Please enter a date.
  
  Group member 15
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Status REQUIRED Adult Youth Please fill out this field.
  
  Youth birthdate
  mm/dd/yyyy
  Please enter a date.
  
  Question/Comment?
  
  Submit
  
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We entrust our mission to Our Lady of Lourdes who is the special patroness for healing.
May our Lady guide us so that those who live with a mental illness know that they are surrounded by her and her Son's healing presence
and remember that they are never alone.

If you are experiencing a mental health crisis, please contact your local emergency services.
The Association of Catholic Mental Health Ministers does not provide medical, counseling, or crisis services. Membership in the Association of Catholic Mental Health Ministers is not and may not be used as a qualification or certification as a minister, counselor, or mental health professional.

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The translations offered from the original English are created through software, not by individual language experts. This may result in some translation errors.

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