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Confirmation Registration Form 2023-2024

- Events/Activities

Individual Youth: You are welcome to register as an individual but an adult must be present at the retreat. If not possible contact Oscar Guzman at 806-414-1061 or text 806-670-5278

Groups: Please register each person (adults and youth) Note: you must have one adult per seven youth.

Note: Youth Form "E" and Adult From "C" must be turn in at the retreat site.
The maximum number of form submissions has been reached. This form is currently not available.
- Confirmation Registration Form
  
  Adult in Charge (Group Leader)
  
  Retreat Date REQUIRED Please fill out this field.
  
  Parish REQUIRED Please fill out this field. Please enter valid data.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mailing Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Home Phone Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED Please fill out this field. Please enter a date.
- ADULTS ONLY (Group Leader - include yourself again unless you are not attending)
- How Many ADULTS? REQUIRED Please fill out this field.
  
  Adult (Sponsors) 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Adult (Sponsors) 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Adult (Sponsors) 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Adult (Sponsors) 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Adult (Sponsors) 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Adult (Sponsors) 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Adult (Sponsors) 7
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Adult (Sponsors) 8
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Adult (Sponsors) 9
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Adult (Sponsors) 10
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Adult (Sponsors) 11
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Adult (Sponsors) 12
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Adult (Sponsors) 13
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Adult (Sponsors) 14
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Adult (Sponsors) 15
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Adult (Sponsors) 16
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Adult (Sponsors) 17
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Adult (Sponsors) 18
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Adult (Sponsors) 19
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Adult (Sponsors) 20
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
- YOUTH ONLY attending the retreat
- How many YOUTH? REQUIRED Please fill out this field.
  
  Youth 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Youth 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Youth 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Youth 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Youth 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Youth 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Youth 7
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Youth 8
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Youth 9
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Youth 10
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Youth 11
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Youth 12
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Youth 13
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Youth 14
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Youth 15
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Youth 16
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Youth 17
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Youth 18
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Youth 19
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
  
  Youth 20
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Number Maximum 20 characters Please enter a phone number.
  
  Birth Date REQUIRED
  Month/Day/Year
  Please fill out this field. Please enter a date.
- Total Youth and Adults X $65.00 per person REQUIRED $ Please fill out this field. Please enter a positive decimal.
- Scholarship and Other Donations REQUIRED Please fill out this field.
Total:

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