Presents
YOU ARE CHOSEN TOB RETREAT
Registration
Parental Permission Form
Name
First Name
Last Name
Date of birth
-
Month
-
Day
Year
Date
Grade in school
Gender
Please Select
female
male
Youth's Email
example@example.com
Youth's phone number
Estimate of monetary donation
Please Select
no donation
$5-$10
$10-20
WAIVER
Hamilton Right to Life- Our Lady of Mount Carmel
Emergency Contact (non-signing guardian or other)
First Name
Last Name
Relation to Emergency Contact
Emergency's Contact Number
Please enter a valid phone number.
Date of Permission
-
Month
-
Day
Year
Date
Signing Guardian's Name
First Name
Last Name
Signing Guardian's Contact Number
Please enter a valid phone number.
Signing Guardian's Email
example@example.com
Signature
Submit
Submit
Should be Empty: