Holy Fire 2019 and Bosco Bash 2020          Adult Registration Form
Diocese of Columbus

This online form must be completed by the adult listed below and not another person on their behalf. If they cannot complete this form and need a paper form instead, please contact our office.

The Diocese of Columbus Holy Fire Package, for which you are registering below, is inclusive of a ticket to Holy Fire on October 13, 2019 (with transportation and a bag lunch) and registration to the 2020 Bosco Bash on March 7, 2020.

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Email *
Name of Parish/School: *
First Name of Adult Chaperone: *
Last Name of Adult Chaperone: *
Gender: *
Date of Birth: *
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T-shirt Size *
T-shirts are for Bosco Bash only and will be received at that event.
Mailing Address: *
City: *
State: *
Zip code: *
Mobile Phone #:
Emergency Contact Name: *
Emergency Contact Phone Number: *
Chronic Conditions, special medical conditions, and/or physical limitations: *
(e.g. Epilepsy; Diabetes; Paraplegic; etc.)
Allergic Reactions: *
(e.g. Food; Medications; Plants; etc.)
Dietary Restrictions: *
Current Medication: *
The Participant is responsible for providing and taking all medication, prescription or non-prescription, required by the Participant.
Medical Insurance:
Policy Number:
Insurance Member's Name:
Insurance Phone #:
Family Doctor Name:
Family Doctor Phone #:
Safe Environment Compliance *
 Current/Valid Background Check
Safe Environment Compliance *
Completed Protecting God's Children Training
Permission, Release and Indemnification, and Code of Behavior *
I have read and agree to all the terms and conditions list in the Permission, Release and Indemnification, and Code of Behavior found here: https://ecatholic-sites.s3.amazonaws.com/15206/documents/2019/5/HFBBAdultReleaseandCodeofBehavior.pdf 
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