St. Rose of Lima Ecuador Retreat Immersion June 14-21 2018
Registration is open until all spots are filled. $500 deposit (cash or check to St. Rose of Lima) is required to complete registration. Please turn in the deposit as soon as you are registered.
Full Name (first, middle, last) *Please make sure this is your full legal name on your passport or ID/documents *
Your answer
Permanent Address *
Your answer
Gender *
Email *
Your answer
Cell Phone Number *
Your answer
Date of Birth *
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Do you have a passport? *
T-Shirt Size *
Proficiency of Spanish [not required for trip] *
[Youth] What year are you in HS and what HS do you attend?
Your answer
[Young Adults - College/Advanced Degree Students] What year are you in school and what school do you attend?
Your answer
[Young Adults - Non-students] What do you currently do for work?
Your answer
Briefly describe why you would like to participate in the Ecuador Retreat Immersion Trip
Your answer
Please indicate any past experience with international travel (i.e. never traveled internationally before, traveled once to Europe, frequent traveler to South America, etc.) *
Your answer
Please indicate any past experience with service or working with vulnerable populations (i.e. service camps, ongoing work with a non-profit, volunteer experiences etc.) *
Your answer
I understand that my registration is not complete until the non-refundable deposit ($500) is paid to St. Rose of Lima. [Due to the Parish Offices no later than 12/1/2017 or once registered] *
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