Middle School Retreat Registration

Middle School Retreat Registration
Event Information

Class/Grade Level : Middle School

Event Description : Retreat at the St. Charles Youth Center, 4904 Trier Rd.

Purpose of Event : Spiritual Formation

Date / Approx. Time of Check-In : Saturday, May 2nd at 8:00am

Date / Approx. Time of Departure : Saturday, May 2nd at 4:45pm
General Information
Teen Name*

First NameLast Name
Preferred Name (if applicable)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Age*
Grade*
MaleFemale
Parish*
CatholicNon-ChristianNon-Catholic ChristianNo Religious Background
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.

Annual Emergency Medical Care Form
Below is our Annual Emergency Medical Care Form. For your convenience, we have embedded it into the general retreat registration form. However, this is technically a separate form which is why you have to type your name and email again. It has a GREEN "Submit" button.

After clicking the GREEN "Submit" button, please be sure to scroll to the bottom of this page and click the BLUE "Next" button.

THERE IS ANOTHER PAGE AFTER THIS! Your registration is not complete yet, so do not close out of this tab!
I am verifying that I have signed and submitted the above Annual Emergency Medical Care Form for my child.

Final Signature
Thank you for registering for this retreat! Please provide a signature below to finalize your registration. If you have questions abour your registration or about the retreat, please contact Anna Laisure at ym.associate.scbfw@gmail.com.
Parent/Guardian Signature*
Should be Empty:

General Information