Be Light Registration

Be Light Registration

These series are designed for married Catholic couples, whether married 1 year or 50 years, to draw each other closer together in Christ while being transformed into family missionary disciples within their own communities. Please register for each night you are able to attend. Light refreshments and deserts are provided; we invite you to bring a side dish to share.
Spouse 1 Full Name

First NameLast Name
Spouse 2 Full Name

First NameLast Name
How many years have you been married?
E-mail

Confirmation Emailexample@example.com
Phone Number
Format: (000) 000-0000.
Parish
Did you attend our Marriage Enrichment Retreat on February 21, 2026?
I would like to sign up for the following dates:
Childcare Registration

We are delighted to offer childcare during our Date Night Series for children who are potty trained through 12 years old. Our childcare team will include at least three experienced adult caregivers who are excited to care for your children while you enjoy the evening.

Ages 0-5

Free Quantity

Ages 6-12

Free Quantity

Total

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Please verify that you are human
Allergies, medical needs, special accommodations, or other important health information:
Consent & Liability Acknowledgment

By registering my child(ren) for childcare during the Be Light Date Night Series, I acknowledge and agree that:
- My child is potty trained and within the eligible age range.
- I have disclosed all relevant medical, behavioral, allergy, and special care information.
- I authorize the childcare team to provide basic first aid to my child if needed.
- I understand that while reasonable care and supervision will be provided, participation is at my/our own risk.
- I agree to promptly pick up my child if contacted by childcare staff for illness, behavioral concerns, or other needs.
- I understand that only authorized adults listed on this form may pick up my child.
Signature
Should be Empty:

Childcare Registration