Love Begins Here Lead Missionary Registration
Welcome to the Love Begins Here Lead Missionary (Chaperone) Registration! We are so excited to have you join us on this wonderful opportunity.

This form is for adult Lead Missionaries who will be chaperoning on a middle school or high school Love Begins Here mission trip.

Once you submit this form, your spot is officially reserved. There is no cost for chaperones to attend, but chaperones must be accompanying a group from a parish and have completed VIRTUS training through the Diocese of Green Bay.   All lead missionaries MUST BE trained in VIRTUS by June 1, 2021!
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First Name of Adult Chaperone *
Last Name of Adult Chaperone *
Parish Group *
This is the parish you are accompanying as a chaperone.
Week(s) you desire to chaperone: *
必填
I am registering as... *
必填
Have you chaperoned on Love Begins Here before? *
必填
Each chaperone will be asked to drive their car with a small student group to the work sites. How many students would you be able to take in your car? *
Example: If your car has 5 seats total, you have room for 4 students (one spot being taken up by you, the driver). Please keep in mind space needed for social distancing.
Home Address of Adult Chaperone *
Street Address, City, Zip Code
Home City and Zip Code of Adult Chaperone *
City, Zip Code
Cell Phone Number of Adult Chaperone *
Email of the Adult Chaperone *
Adult Chaperone Date of Birth *
MM
/
DD
/
YYYY
Will you be 21 years old or older during your time at LBH? *
Size of shirt *
In case of emergency, please contact: *
First and Last Name
Relationship of Emergency Contact to You *
First and Last Name
必填
Home Phone Number of Emergency Contact *
Cell Phone Number of Emergency Contact *
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