St. Clare - Diocesan Youth Retreat Interest Form

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Please complete this interest form for all levels of interest for DYR. If you are still deciding or already know that you are going/registered, you should fill this form.

This form is not binding to any registration. It is simply to gather information for those that are interested to begin fundraising. Filling out this form will not promise any scholarship money.

Our policy at St. Clare is to help retreatants who have a real desire to go to DYR as best as we can, but we cannot provide full scholarships to individuals.

For more information, please contact Ryan.bao@dsj.org

Name (First, Last) *

I will be in _____________ in the Fall of 2024 *

8th Grade

9th Grade

10th Grade

11th Grade

12th Grade

Freshman in College

Other:

Email Address (Or best way to contact you) *

Are you registered for DYR? *

Yes

My level of interest for DYR *

5 - I will go to DYR, there's nothing that will stop me!

4 - I want to go to DYR, but there are some circumstances

3 - I am okay with not going, but also okay with going to DYR

2 - I am leaning towards not going to DYR, but it depends on circumstances

1 - I am leaning towards not going to DYR, but still a bit interested

I won't be able to go to DYR unless... *

The retreat will be about $550

I receive a scholarship >$250

I receive a partial scholarship <$200

I will not need any financial assistance

I am willing to fundraise to help pay for my registration to DYR *

In order to receive scholarships from St. Clare, you must participate in fundraising efforts.

Yes

Maybe

Other:

I mostly am available for fundraising/potential meetings on

Check all that apply

Afternoon

Evening

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

A fundraising idea I have is...

Submit

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