Prayer and Action 2025 Registration

Prayer and Action Registration
CHILD INFORMATION:

Those who have completed 8th grade, through those who have completed their senior year are invited to attend Prayer and Action 2025! **Current college students! If you are wanting to drop-in for a day for attend for a longer period of time, please email me to work out the details: gheimerman@dcdiocese.org**
Child Name*

First NameLast Name
Grade*
(Grade completed as of May 2025.)
Name of Home Parish*
Mission Week/Location
T-Shirt Size
PARENT/GUARDIAN INFORMATION:
Tip: Don't worry, the extra details - specific times, addresses, medical/release forms, and packing lists - will be sent to you after completing the registration.
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
E-mail*
Are you planning to attend as a chaperone? (It does not cost any extra this year, and we could really use the help!)

YesNo
T-Shirt Size
How will this registration be paid?

Credit/Debit card or PaypalI will send a checkThe parish will send a checkOther
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Single Registration$100.00
This registration fee is for one student participant. The money helps cover the meals, shirts, supplies, and operating costs.

Total $0.00
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The payment is ready! It will be completed once you submit the form.
Please explain:
(In some cases, the local parish is willing to pay the registration fees for their students, or it is desired by the parents to pay with an alternative method. If you plan to do so, please indicate as such above, and make any checks payable to:

Prayer and Action - DCD

And mail to:

Catholic Diocese of Dodge City
ATTN: Gentry Heimerman
910 Central
P.O. Box 137
Dodge City, Ks 67801
Should be Empty:

Prayer and Action Registration

CHILD INFORMATION:

PARENT/GUARDIAN INFORMATION: