ECYD Team Leader Training

PARTICIPANT INFORMATION

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Birthdate REQUIRED Please fill out this field. Please enter a date.

School REQUIRED Please fill out this field. Please enter valid data.

Grade in School (2022-2023) REQUIRED Please fill out this field. Please enter valid data.

T-shirt Size REQUIRED Small Medium Large X Large XX Large Please fill out this field.

Challenge Club Name REQUIRED Please fill out this field.

Allergies Please enter valid data.

Does participant have any behavioral, psychological or medical situations to be aware of? REQUIRED Yes No Please fill out this field.

If yes, what types of accommodations would she need over the retreat weekend, if any? A member our pastoral team will be in touch with you. Please enter valid data.

EMERGENCY CONTACTS: If, in the event of a medical or other emergency, I/We am/are unable to be reached by telephone at the numbers listed below, I/We authorize the activity supervisor(s) to attempt to contact me/us through the alternative emergency contacts listed below.

Parents/ Guardians Contact Information

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.

Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Alternate Phone Number Please enter a phone number.

Alternative Emergency Contact Information

Name Please enter valid data.

Relation Please enter valid data.

Cell Phone Number Please enter a phone number.

Alternate Phone Number Please enter a phone number.

Name 2 Please enter valid data.

Relation Please enter valid data.

Cell Phone Number Please enter a phone number.

Alternate Phone Number Please enter a phone number.

I give permission for Event Supervisor(s) and Club Leader(s) to communicate with my child using text messaging and/or email regarding the details of the Activity / Program (Only participants 15 years old and older). REQUIRED Yes, I give permission for my child to be contacted. No, I do not wish to have my child contacted. Please fill out this field.

Child's Email Please enter an email address.

Child's Phone Number Please enter a phone number.

I would like to be copied on all emails and text messages to my child. Yes No

Parent's Email (if different than emergency contact) Please enter an email address.

Parent's Phone Number (if different than emergency contact) Please enter a phone number.

Date REQUIRED Please fill out this field. Please enter a date.

Parent 1 Name REQUIRED Please fill out this field. Please enter valid data.

Parent 2 Name Please enter valid data.

Are you interested in volunteering as a chaperone? (Must be SafeParish/Virtus Trained) REQUIRED Yes On Please fill out this field.

*RC Activities reserves the right to deny acceptance to any applicant at any point in this process.

NOTE: Cancelations will receive a refund for the amount paid less $10 to cover our bank fees and processing costs.

Retreat Fee95.0

Your additional donation is appreciated to support the ministry of our LC priests and Consecrated Women of Regnum Christi, who are running this retreat. Thank you!

Additional Donation $ Please enter a positive decimal.

ECYD Team Leader Training

Event Details

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