2019 Confirmation Retreat Registration Form
All Retreat Registrations must be complete by Friday, October 4, 2019.  
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Student First Name *
Student Last Name *
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 *
Parent 1: Email *
Parent 1: Phone Number *
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
Parent 2: Cell Number
Parent 2: Email
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.)
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Additional Emergency Contact Name
Additional Emergency Contact Phone Number
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
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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.) *
Please list any other helpful information about your student....
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