2026 Fall 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, October 3rd at 8:00am in the Church

Date / Approx. Time of Departure : Saturday, October 3rd at 4:45pm in the Youth Center
General Information
Participant Name

First NameLast Name
Preferred Name (if applicable)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Age
Grade
Gender
Parish
Faith 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!
Please check before moving on.

Final Signature
Thank you for registering for this retreat! Please provide a signature below to finalize your registration.

If you have questions about the retreat, please contact Vincent Wallace at middleschoolministry@scbfw.org.

If you have questions about your registration or about our annnual emergency medical forms, please contact Anna Laisure at alaisure@scbfw.org.
Parent/Guardian Signature
Should be Empty:

Middle School Retreat Registration