Youth Retreat January 29, 2022

- Ministries

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- 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 REQUIRED Please fill out this field. Please enter an email address.
- 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.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Where do you attend youth group? REQUIRED Please fill out this field.
- If you attend youth group at another parish then the ones previously listed please write the name of the church and city where you attend. Please enter valid data.
- Do you have any dietary restrictions or allergies? REQUIRED Yes No Preference Please fill out this field.
- If you have any dietary restrictions or allergies please select the most applicable. REQUIRED Please fill out this field.
- If you have any other dietary restrictions, allergies or medical needs not listed above please describe below. If not please enter NONE. REQUIRED Please fill out this field. Please enter valid data.
- Please enter a name for an emergency contact. REQUIRED Please fill out this field. Please enter valid data.
- Emergency Contact Phone Number REQUIRED Please fill out this field. Please enter valid data.
- Emergency Contact Phone Relationship REQUIRED Please fill out this field.
- If you selected "Other" on the previous question please describe who your emergency contact is. Please enter valid data.
- Have you attended a youth retreat at St. Stephen's before? REQUIRED Yes No Please fill out this field.
- How did you hear about this retreat? REQUIRED Please fill out this field. Please enter valid data.
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Documents
- Parent release form please print and sign
Your Friends can scan this QR code to register.