2022 Confirmation Retreat

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February 26, 2002, from 8:45am-5:30pm
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Cost: $50.00 per Candidate.
Please make checks payable to St. James with "Confirmation Retreat" in the memo line.

RETREAT WILL TAKE PLACE AT ST. JAMES W220 N6588 Town Line Rd., Menomonee Falls 53051

***Please complete this registration ASAP!

First Name *

Last Name *

Choice of Retreat Date *

Saturday, February 26th: 8:45am-5:30pm

PARENT/GUARDIAN FULL NAME *

HOME ADDRESS *

PRIMARY EMAIL ADDRESS *

ALTERNATE EMAIL ADDRESS

BEST PHONE TO CONTACT DURING EVENT *

ALTERNATE PHONE *

ALTERNATIVE CONTACT (If unable to reach you) *

ALTERNATIVE CONTACT BEST PHONE DURING EVENT *

PHYSICIAN'S FULL NAME *

PHYSICIAN'S PHONE *

NAME OF MEDICAL INSURANCE *

MEDICAL INSURANCE POLICY NUMBER *

PERTINENT MEDICAL CONDITIONS

INHALER/EPI-PEN

My child MAY carry and self-administer.

My child MAY NOT carry and self-administer

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ANY FOOD ALLERGIES TO BE AWARE OF?

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