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

This form is for Chaperones 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.
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First Name of Adult Chaperone *
Last Name of Adult Chaperone *
Week(s) you desire to chaperone: *
Required
I am registering as... *
Required
Have you chaperoned on Love Begins Here before? *
Required
Parish *
This is the parish you are accompanying as a chaperone.
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).
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
Required
Home Phone Number of Emergency Contact *
Cell Phone Number of Emergency Contact *
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