2015 Mariapoch Teen Campout

Please complete the following form to register for the Mariapoch Teen Campout, August 1-2, 2015.

(All boxes with a red star must be filled out in order to submit. If something does not apply to you, please type "N/A" in the box. If you have a problem filling out this form, please call 440-834-0290.)

For Teens: Please include a copy (front and back) of your medical insurance card, prescription card (if separate from your medical plan), and dental card. These are required if emergency care is needed. Print the Release Form (a link will be provided once you submit this form) and return with the participant's medical cards and $25 registration fee to the address below.

Mariapoch Campout
Christ the Bridegroom Monastery
17485 Mumford Rd.
Burton, OH 44021

Make checks payable to Eparchy of Parma.

DEADLINE: Monday, July 20, 2015

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