Diocese of Green Bay Extended Steubenville Registration - Chaperones
Welcome to the registration and liability form for the Diocese of Green Bay's Steubenville Extended Pilgrimage July 17th-23rd to Franciscan University - Steubenville, Ohio! We are so excited to have you join us on this wonderful opportunity.

This form is for CHAPERONES ONLY: adults, priests, and young adults.

No paper form will be needed as this acts as your liability form and registration. Once you submit this form, your spot is officially reserved.

First Name of Adult Chaperone *
Your answer
Last Name of Adult Chaperone *
Your answer
Male or Female? *
I am registering as... *
Required
I am registering as... *
If registering as part of a group, what parish or school are you registering under? *
Your answer
Home Address of Adult Chaperone *
Street Address, City, Zip Code
Your answer
Cell Phone Number of Adult Chaperone *
Your answer
Email Address of the Adult Chaperone *
Your answer
Adult Chaperone Date of Birth *
Your answer
Student Shirt Size *
In case of emergency, please contact: *
Your answer
Relationship of Emergency Contact to You *
Your answer
Main Phone Number of Emergency Contact *
Your answer
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