2019 Confirmation Retreat Registration Form
All Retreat Registrations must be complete by Friday, October 4, 2019.
Student First Name *
Your answer
Student Last Name *
Your answer
Gender *
Grade level *
We will do our best to accommodate your preference in selecting which retreat date you would like your Confirmand to participate. However, please understand we may not be able to guarantee everyone their first choice as there is limited space each weekend.
My first choice for retreat weekend is: (Please ONLY mark your child for their correct gender.) *
Parent 1: First and Last Name *
Your answer
Parent 1: Email *
Your answer
Parent 1: Phone Number *
Your answer
Yes, I would be willing to volunteer and attend the retreat with my child. (You will need to be finger printed and Safe-Environment Trained.) *
Parent 2: First and Last Name
Your answer
Parent 2: Cell Number
Your answer
Parent 2: Email
Your answer
Yes, I would be willing to volunteer and attend the retreat with my child. (You will need to be Safe-Environment Trained and Finger printed.)
Additional Emergency Contact Name
Your answer
Additional Emergency Contact Phone Number
Your answer
Where is your student receiving Religious Education? *
Dietary restrictions *
If we cannot reach a parent by phone, we have permission to provide the following medications to your student... *
Required
Please list known Allergies
Please list any prescription medication and instructions for taking that student needs during the weekend. (We will need a medical volunteer to assist with this.) *
Your answer
Please list any other helpful information about your student....
Your answer
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