St. Charles Men’s ACTS Retreat Retreatants

Personal Information:
Full Name (First and Last)*
Preferred Name*
Age*
Date of Birth*

MonthDayYear
Shirt Size*

SmallMediumLargeX-LargeXX-LargeOther
Shirt Size Holder
Driver's License Number*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
# of Teams Served On*
Cell Phone*
Email Address*
example@example.com
Home Parish*

St CharlesOther
Denomination*
Parish Holder
I attend church*

FrequentlyOccasionallyNever
I am active in the following ministries:*
List all ministries your involved in
Date ACTS Retreat Attended as Retreatant*

MonthDayYear
Date
Parish I attended my Retreat With*
Additional Considerations:
Allergies*
Dietary Needs*
Smoking Preference*
Medical Concerns*
Emergency Information:
Emergency Contact*
Relationship of Contact*
Emergency Contact Phone Number*
Emergency Contact Cell Number*
Deadline to return application to the parish office is Sunday March 1st.
Should be Empty: