Teen ACTS Registration Form

Teen ACTS Registration Form

Parents Information

Emergency Contact
Name*

First NameMiddle NameLast Name
Relationship*

FatherMotherSiblingGrandparentRelativeFriend
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
The total retreat fee is $150 per participant. Once you submit this registration form electronically, the CORE Facilitator will contact you and/or your parents to provide more details about the selection process and available payment options.

If you have questions about the ACTS Retreat or Registration, please contact:

St. John Neumann Parish

Christy Pedraza (956)645-5959 - ACTS CORE Facilitator

Aaron Gonzalez (956)693-8932 - Youth Minister

St. Jude Parish

Alma Villarreal (956)235-7351 - ACTS CORE Facilitator

Gabby Arriaga (956)326-7282 - Youth Minister

I understand that ACTS Missions will collect all retreatant information for quality purposes and testimonials. I also understand that ACTS Missions may contact me after this ACTS Retreat to get feedback on my experience and see if I would like to participate and support future ACTS Retreats. I understand that ACTS Missions will NOT release my personal information to outside agencies.

PLEASE NOTE THAT THERE IS NO ALCOHOL ALLOWED IN THE ACTS RETREAT
Retreatant Signature*

Clear
Parent/Guardian Signature (if under 18 years of age)

Clear
Retreatant signature date*

MonthDayYear
Date
Parent Guardian signature date

MonthDayYear
Date
Should be Empty: