St. Charles Women’s ACTS Retreat for Retreatants

Personal Information:
Full Name (First and Last)*
Preferred Name*
Age*
Shirt Size*

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Shirt Size Holder
Phone Number*
Email Address*
example@example.com
Marital Status*

SingleMarried
Address*

Street Address

Street Address Line 2

CityState

Zip Code
I am a registered member of*

St CharlesOther
Denomination*
Spouse’s Name*
Spouses Phone Number
Parish Holder
Financial difficulties should not prevent anyone from attending this retreat. If you have financial concerns, please click here and the Parish Office will contact you so that confidential agreements can be made.*
Financial Assistance is needed
Additional Considerations:
Allergies*
Dietary Needs*
Smoking Preference*
Medical Concerns*
Emergency Information:
Emergency Contact*
Relationship of Contact*
Emergency Contact Phone Number*
Emergency Contact Cell Number*
Emergency Contact that does not live with you*
Relationship of Contact*
Emergency Contact that does not live with you Phone Number*
Deadline to return application to the parish office is 4 pm Monday, June 16th.
Once you have completed the registration form, select the Submit Button below and you will be redirected to our payment portal. ($60 Deposit or $170 Payment in full)
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