Kairos 2017-2018
Please fill out the form below to select your Kairos.

*** We will confirm which retreat you received in August.

*** Assignments are first come first serve.

*** Ineligibility will affect your status for the retreat.

*** If you are applying for a Companions Trip, you must attend a Kairos prior to your earliest timeframe selected.

First Name (Student) *
Your answer
Last Name (Student) *
Your answer
Student Email *
Most Commonly Used
Your answer
Address (Student) *
Your answer
City (Student) *
Your answer
State (Student) *
Your answer
Zip Code (Student) *
Your answer
Home Phone (Student)
Please include area code
Your answer
Cell Phone (Student)
Please include area code
Your answer
Retreat choice: *
Please select your top choice. If the options are there, then you will get your top choice.
Mother's Information
If any information is not applicable, please mark N/A in the text box.
First Name (Mother's) *
Your answer
Last Name (Mother's) *
Your answer
Address (Mother's) *
IF DIFFERENT FROM ABOVE, PLEASE FILL OUT.
Your answer
City (Mother's) *
IF DIFFERENT FROM ABOVE, PLEASE FILL OUT.
Your answer
State (Mother's) *
IF DIFFERENT FROM ABOVE, PLEASE FILL OUT.
Your answer
Zip Code (Mother's) *
IF DIFFERENT FROM ABOVE, PLEASE FILL OUT.
Your answer
Email (Mother's)
Your answer
Home Phone (Mother's) *
IF DIFFERENT FROM ABOVE, PLEASE FILL OUT.
Your answer
Cell Phone (Mother's) *
Your answer
Work Phone (Mother's) *
Your answer
Father's Information
If information is not applicable, please write N/A in the answer box.
First Name (Father's) *
Your answer
Last Name (Father's) *
Your answer
Address (Father's) *
IF DIFFERENT FROM ABOVE, PLEASE FILL OUT.
Your answer
City (Father's) *
IF DIFFERENT FROM ABOVE, PLEASE FILL OUT.
Your answer
State (Father's) *
IF DIFFERENT FROM ABOVE, PLEASE FILL OUT.
Your answer
Zip Code (Father's) *
IF DIFFERENT FROM ABOVE, PLEASE FILL OUT.
Your answer
Email (Father's) *
Your answer
Home Phone (Father's) *
IF DIFFERENT FROM ABOVE, PLEASE FILL OUT.
Your answer
Cell Phone (Father's) *
Your answer
Work Phone (Father's) *
Your answer
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